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ROUGH THE YEARS 



TUT IT 



HEALTH 

NU :;ing 







THE UNIVERSITY OF 
BRITISH COLUMBIA 




WOODWARD HISTORICAL 
COLLECTION 






THROUGH THE YEARS 

WITH 

PUBLIC HEALTH NURSING 



A History of Public Health Nursing 

in the Provincial Government Jurisdiction 

British Columbia 

- By 

Monica M. Green 




Published by 
The Canadian Public Health Association 



Monograph Series, "Public Health in Canada 7 ' 
Scientific Editor: John M. Last MD 



Price $8.50 
First Edition 1984 




Copyright 1983 Canadian Public Health Association 
1355 Carling Avenue, Suite 210, Ottawa, Ontario, Canada KIZ 8N8 

All rights reserved including the right to 
reproduce in whole or in part in any form. 



Printed in Canada by: 
M.O.M. Printing, 300 Parkdale, Ottawa, Ontario K1Y 1G2 

ISBN 0-919245-23-4 




MONICA M. GREEN 



ACKNOWLEDGEMENTS 

Public health nurses, in British Columbia have demonstrated leadership in 
developing preventive health services, and in promoting health on a local or 
community level. 

This history has been written as a tribute to the many public health nurses who 
through the years built a solid foundation for the present day community health 
nursing service. The story of the step by step development of the public health 
nursing service will assist younger nurses to understand how the service evolved 
as the Province grew and society changed. The contribution of many public 
health nurses and colleagues made this History possible. 

I am grateful for the support of the British Columbia Ministry of Health, and 
the Director of Public Health Nursing, Miss Lavinia Crane, who encouraged me 
to continue after a slow start; to Miss Alice Beattie, who spent a great deal of 
time reviewing the material and verifying events; to Dr. J. A. Taylor, who was 
particularly helpful concerning the early days; to Mrs. Joyce Brake, Camosun 
College Instructor, who arranged the first typing by her student, Mrs. Yung 
Quach; to Dr. David A. Clarke, President of C.P.H.A., who supported the 
project, and theC.P.H.A. Executive Director, Mr. Gerald Dafoe for publishing 
the book and Dr. John Last for editing. 

Very much appreciated is the financial assistance received from the British 
Columbia Heritage Trust. 
(1) The British Columbia Heritage Trust 



Table of Contents 

I. PIONEER DAYS I 

First Permanent Provincial Medical Health Officer (1899) 5 

The Early 1900s and Some of the Health Problems 5 

School Nurses Are Needed 5 

The School Medical Inspection Act of 191 1 6 

First Provincial School Nurse — 1913 6 
School Nurses Appointed in Larger Cities 
Better Follow-up of School Medical Inspections Needed 

The Public Conscience Awakens After The War 8 

The New System of Public Health Nursing 8 
The First Course for Public Health Nurses Commences at 

The University of British Columbia 9 

II. THE PROSPEROUS TWENTIES 11 

The Public Health Nursing Service Commences 12 

Public Health Nursing a Success 14 
New Incentives to Stimulate the Organization of Public 

Health Nursing Districts 14 

Health Centres and Nursing Districts Commence 15 

How the Public Health Nurse Operated (Office, Clinics, etc.) 16 

The Early Record System 18 

Public Health Nursing in the Twenties 20 

The Public Health Nurses' Bulletin and Selected Reports 23 

Public Health Nursing Uniforms and Insignia 28 

The Public Health Nursing Service Grows in the Twenties 28 
The Public Health Nursing University Course 

Becomes a Requirement 30 
The First Move Towards Full Time Medical Health Officers 

and the First Health Unit 30 

The Twenties Introduce the Health Unit Concept 3 1 

Tuberculosis Nursing Supervisor for Public Health Nurses 32 

III. THE DEPRESSION YEARS —THE THIRTIES 35 

Public Health Nursing in the Depression 36 

Gradual Expansion in the Thirties 41 

Getting Around in the Thirties 43 

The Generalized Service Established as Best 45 

New Health Units in the Thirties 46 

More Health Protection Needed 47 

The First "Refresher Course" 47 
Dr. H. Esson Young Directs the Public Health Nursing Service 48 

The Need for a Public Health Nursing Director 48 



Public Health Nursing Variations in the Thirties 49 

IV. THE FORTIES — THE WAR YEARS AND AFTERMATH 51 

Population Growth in the Forties 52 

The First Public Health Nursing Director 53 

The Division of Public Health Nursing Gets Under Way 54 

Public Health Nursing News and Views 56 

Travel in the Forties 56 

Study Groups for Public Health Nurses 59 

The Public Health Nursing Council 61 
Public Health Nurses as Venereal Disease Epidemiology 

Workers 63 

Changes in the Public Health Nursing Division 63 

The Second Director of Public Health Nursing 64 

Public Health Nurses do Immunizations 66 

World War II is Over 67 

The Department of Health and Welfare Formed — 1946 68 

The Reorganization of the Public Health Nursing Service 68 

The Public Health Institute 70 

The Public Health Nurses' Uniform Insignia 76 

The Public Health Nurses' Uniforms of the Forties 76 

The First Organized Home Care Program — 1947 77 

The Third Director of Public Health Nursing 78 

The Great Flood of 1948 79 

What the Generalized Public Health Nurse Did in the Forties 80 

Public Health Nursing Service on Selected Indian Reserves 81 

Tuberculosis Field Nursing 82 

First Time Study and Case Load Analysis — 1948 82 
Federal Health Grants Assist the Development of the 

Public Health Nursing Service 83 

Some Factors Creating Nursing Changes in the Late Forties 83 
The Need for More Local Public Health Nursing Supervision 84 

The Plan for Local Supervision and First Appointments 84 

The Criteria for Supervisory Positions 87 

Professional Training Plan for Supervisory Nurses 87 
Continuing Shortage of Public Health Nurses Spawns 

the Internship Training Plan 89 

The Hamilton Report — 1949 90 

V. THE FANTASTIC FIFTIES AND THEIR INFLUENCE ON 
PUBLIC HEALTH NURSING 93 

How Programs Changed 94 

The Baillie — Creelman Report — 1950 98 
Poliomyelitis Becomes the Major Communicable Disease 

Concern 99 



The Atomic Age Brings Civil Defence Nursing 101 

Awards for Distinguished Service — (Diphtheria Epidemic) 101 

Organized Home Care Programs Extend 107 

New Community Health Centres 109 

Negotiations and Bargaining 1 10 

Public Health Nursing Consultants' Program 1 1 1 

Improvements in Working Conditions 1 14 

VI. THE TURBULENT SIXTIES 121 

The Number of Public Health Nurses Increases 123 

Some Administrative Changes 124 

Home Nursing Expands at Ten Cents Per Capita 126 
First Procedure Manual and Physiotherapists for Home Care 127 

Public Health Nursing Liaison with Hospitals and Doctors 128 

Involvement with Mental Health Increases 129 

More Public Health Nursing Help for the Elderly 130 
More Indian Reserves Served by Provincial 

Public Health Nurses 132 

Preventive Programs Expand 132 

Research Studies in Public Health Nursing 137 

Health Unit Aide Service Expands 138 

Institute and Other Staff Education Changes 139 

Federal-Provincial Public Health Nursing Consultation 139 

The Sixties End 140 

VII. THE SEVENTIES BEGIN 143 

Hospital Days Replacement Program Initiated 144 
Home Care Programs Increase and Co-ordinators Appointed 145 

Public Health Nursing Liaison Increases 146 

More Experimental Programs 146 

Health Promotion Adds New Dimensions 146 

Renewed Emphasis on Preschool Assessment 147 
Public Health Nursing Community Care Co-ordinators 

Appointed 148 

Public Health Nursing Uniforms Become History 148 
Staff Education Programs Adjusts to Increased Numbers 

of Public Health Nurses 149 
Changes in the Educational Preparation of Public Health 

Nurses 150 

Public Health Nurses Attain Bargaining Rights 152 
Changes in the Division of Public Health Nursing to the 

Mid-Seventies 153 

Conclusion 155 

Bibliography 155 



Appendices 



I. FIRST APPOINTMENTS AS PUBLIC HEALTH NURSES 

OR SCHOOL NURSES TO NEW DISTRICTS BY YEAR 158 

II. FIRST SENIORS OR SUPERVISORS BY DISTRICT 

AND YEAR 163 

III. CHANGES IN THE DIVISION OF PUBLIC HEALTH 

NURSING AND SPECIAL SERVICES 166 



I. PIONEER DAYS 




Public Health Nurses Shirley Robinson, Alice Beattie and Ruby Dunn 
wave goodbye to the S.S. Minto, Nakusp, Arrow Lake — 1951. 



Pioneer Days 

Public health nursing in British Columbia had its roots in the pioneerdays. It 
developed slowly, adapting to changes, as the most westerly province in Canada 
emerged into present day society. Nurses of an earlier era shared the rugged 
country and problems of the early settlers, and overcame many difficulties to 
evolve into the efficient present day public health nursing service. The history of 
public health nursing is closely tied to the development of the province, and is 
woven into the fabric of the provincial health department and the evolution of 
local health services. 

When British Columbia became a province in 1871, it had a very small 
population, consisting of only 34,247 persons, with Victoria and New Westmins- 
ter the only towns. The bulk of the population was not included in the census as it 
was on the move following the discovery of gold in places such as Yale, Lillooet 
and Barkcrville. There was no organized health service, although a Provincial 
Board of Health existed and could be called into action to deal with emergencies 
such as epidemics of cholera, typhoid fever and smallpox. 

The vast geographical area of British Columbia with its unique topography 
presented many challenges to the development of a public health nursing service 
for all the people of the province. The small population was centred on Van- 
couver Island and the lower mainland with the remainder scattered over the 
large area of the province. Access to many areas was difficult because of the 
rugged coastline in the west, and the mountain ranges of the interior, which were 
gradually settled as boats, roads, railways and airlines improved transportation 
and communication. Nine distinct geographical areas emerged as the result of 
settlements along the rivers, valleys and plains. They were Vancouver Island, 
Greater Vancouver, Fraser Valley, Okanagan, Cariboo, Skeena, Peace River, 
Kootenays and Coast Garibaldi. The population centres of these areas remained 
near the main highways, leaving vast areas of rocky, mountainous, and wilder- 
ness country with little or no populaton. Over fifty percent of the total popula- 
tion continued to be located in Greater Vancouver and the Fraser Valley. As a 
result, for many decades Vancouver was the main health resource and education 
centre for the entire province. Forestry, fishing and mining have played a large 
part in the economic development of the province and have tended to create a 
very mobile and transient population where many men work apart from their 
families over long periods of time. Although some stable farming communities 
exist they have not had a dominating effect on the way of life in the province. 
Many small towns and cities have transient populations which fluctuate in size 
with the rise and fall of the changing economy. These factors tend to create 
individual and family health problems. 



BRITISH COLUMBIA'S 
GEOGRAPHICAL REGIOMS 







QUEE 
CHARLOTTES 



VANCOUVER 
ISLAND 



First Permanent Provincial Medical Health Officer — IK?*) 

The population grew slowly and by 1899. as it ncared 100.000. the first 
permanent health officer w.is appointed when I)r C.J. I agan. a medical practt- 
i Miner, u.is appointed Secretary oi the Provincial Board of Health. I he organ 1- 

/.ition was the forerunner of the present Provincial Ministry of Health, and Dr 
I agan assumed practical control of all matters relating to health. The Provincial 
Hoard of Health had been formed originally to cope with emergencies such as 
outbreaks ol smallpox or typhoid and to deal with matters such as cemeteries, 
removal of nuisances etc. Dr. Pagan was concerned, however, with the total 
health of the people and their environment. 

The Early 1900s and Some of the Health Problems 

Bv 1911, the population had increased to 393.000 and about this time there 
was a sudden influx ol people to the province which was reputed to be the great 
land ol opportunity. Land development companies started to bring in settlers 
from Britain, the prairies and the United States to establish farms and ranches in 
the Okanagan and on Vancouver Island. Small communities sprang up near the 
mines, saw mills, logging operations and fish canneries in the interior and north- 
ern coastal areas. Vancouver had become the terminus of the Canadian Pacific 
Railway with 100.000 population. Reports indicated the following population 
figures in interior centres: Trail, 2000; Rossland. 5000 miners. 1000 men and 
Families, 2000 transients and 100 Chinese; Quesnel. 100 whites, 100 Chinese; 
\slu Toft. 300 whites, 50 Chinese. Communities existed at Barkerville. Golden. 
Port Steele, Nelson, Kaslo, Revelstoke, Nakusp, Alberni, Duncan and Chcmai- 
nus. At this time too, 8000 Japanese, 2000 Sikhs from India, and 1500 Chinese 
•ntered the province from Asia. The diverse population with its varied cultural 
background was scattered throughout the province and presented a fertile field 
or health problems. A concerted effort was needed todo something about them. 

Dr. Fagan investigated health problems and published his findings and 
^commendations in the Annual Reports of the Provincial Board of Health. In 

913. tuberculosis was the leading cause of death and accounted for 10% of all 
leaths. In addition other contagious diseases accounted for a further 7', of all 
leaths. Children were particularly susceptible to contagious diseases and in 

914. Dr. Fagan reported a 25% death rate from all causes for children under 
wo years of age. He was particularly concerned about tuberculosis control and 
he need for better infant and child care and he was determined to do something 
bout these problems 

chool Nurses Are Needed 

\s early as 1 90S. 1): lagan recommended that t he "health ol schoolchildren 
tould be constantly and systematically supervised by specially trained nurses, 
ho could not only attend to many health matters, but also impart reasonable 



and practical knowledge of health matters, and refer those requiring care to their 
physicians." He also stated "there is a need for school nurses to visit schools 
daily, take note of sore throats, prepare cultures for examination in the labora- 
tory for diphtheria bacilli, and visit the homes of children absent without known 
cause to help reduce the incidence of diseases such as diphtheria and scarlet 
fever." It was some time before his recommendations would be put into effect! 

The School Medical Inspection Act of 1911 

It was during Dr. Fagan's time that important legislation was passed which 
was to have a far-reaching effect on public health nursing. This was "An Act to 
Provide for the Medical Inspection of Schools" of 1911. This act was guided 
through the Legislature by Dr. H. Esson Young, Minister in the McBride 
government, who was responsible for the Provincial Board of Health and the 
Department of Education. Dr. Young was to assume the position of Secretary of 
the Provincial Board of Health in 1915 following Dr. Fagan's retirement in 1914. 

The Act provided for the medical examination of every school child in the 
province once a year. A complete record of the physical condition of each child 
was to be entered on a card which would remain in the school, and transfer when 
the child changed schools. The card was to be filled in by the medical examiner, 
and show the results of each year's examination during the child's school life. 
The Act provided for a report to be sent to parents pointing out the existence of 
defects, and advising that the family physician or dentist be consulted as indi- 
cated. Local physicians were appointed to do the medical inspections at the 
schools. The Act also provided that the municipalities and cities would pay for 
the service in their areas and that the Provincial Board of Health would pay for 
the service in the large unorganized areas of the province. 

First Provincial School Nurse — 1913 

The School Medical Inspection Act was a good beginning, but it was apparent 
that medical inspections alone were not the answer to the poor health and 
contagious diseases found among school children. Also, as medical inspections 
proceeded, it was apparent that some assistance was needed to help with organi- 
zation, planning and the follow up of the results. Accordingly, Miss Blanche 
Swan (Lewis) was appointed in 1913 as the first provincial school nurse, whose 
job was to assist with the school health program. She was assigned to field work 
in the unorganized territory. She was to see that the School Inspection Reports 
by the school medical inspectors were properly filled in, and to impress teachers 
with the importance of the new medical program. Miss Swan helped with the 
administration of the program from her headquarters in Victoria. She visited 
rural districts, helped with the medical inspections in numerous schools, and 
wrote annual reports, as well as consolidating the data received from various 
schools. 

In her annual report in 1915, Miss Swan recommended that school nurses be 



cmplo\cd in local districts, where ihc> would be able to follow up the results of 
Ihc medical inspections She also stressed the need for improved school imita- 
tion She was sent to investigate chemical closets that were in use on \ ancouver 
Island, and lound ihcm to be a lailurc in rural schools In (act she was able to 
show that thc> were a source of contagious disease I he chemical toilets were 
discarded as ihc result of her investigation It is interesting to note that about this 
time school boards were asked to oil the school floors to reduce dust, as studies 
had shown (hat this practice would reduce the bacterial count in the air Oiling ol 
Moors wot Continued into the lorties in most rural schools 

In I9lh. a second provincial school nurse. Miss \ I ocke was added I hese 
centralis located nurses were eventual!) replaced b\ local nurses as the need lor 
more nursing service lor the school age child was realized. 

School Nurses \ppointcd in Larger ( ities 

Immediate!) alter the School Medical Inspection Act was passed, a lew school 
nurses were appointed b\ school hoards, either lull or part-time in the larger 
cities Miss I lizabeth Breeze, in 1910 became the first school nurse in Nan- 
comet, and was charged with supers ising the health ol 9800 school children in 
16 schools Her lirst report stated that her duties included inspection of children 
lor cleanliness, skm conditions such as impetigo, scabies and the ever-preseni 

pediculosis M\ 1915 there were five registered nurses employed as school nurses 
Miss E. Brec/e. Miss \ Mel cllan. Miss A .Idlers. Miss E. I wart and Miss 

II Bone 

\ ictoria School Hoard employed Miss M (iimmer. while Miss Alice Stark 
was employed in New \\ est minster Kelowna and Kamloops cmplo\ed Miss H 

Shayler. 

I he employment Ol registered nurses as school nurses continued into the 
1 920*9 when a new system ol registered nurses trained additionally in public 
health was introduced. The work ol the school nurses was directed towards 
improving the health ol school children mainl\ through the reduction ol conta- 
gious diseases and skin infections; inspection of children for delects such as 
dental decay, abscessed tonsils, skm conditions etc. Weighing and measuring 
and health teaching were part ol the nurse's program She also helped enforce 

quarantine regulations and visited parents at home to discuss the children's 
health problems Hei work varied according to the w ishes ol the school board. 

the school medical inspector and her own priorities 
Better lollow-up of School Medical Inspections Needed 

When l>i V oung was appointed Secretary ol the Provincial Hoard o\ Health 
in 1915, five \cais had elapsed since the School Medical Inspection program had 
been started, and he was anxious to know how successful it had been. Accord - 
mgh he sent questionnaires to the teachers m unorganized areas to obtain their 
opinions regarding the results of the program. I he teachers were unanimous in 



their opinion that great benefits had resulted for some children, particularly 
among parents who appreciated that certain defects, if not corrected, harmed the 
child both physically and mentally. These parents took steps to have problems 
corrected. However, they said that many parents were indifferent or antagonis- 
tic. Dr. Young concluded that the weakness in the procedure was the absence of 
follow up explanations to parents concerning the need for proper medical or 
dental attention. He stated that there was a great need to improve the follow up 
system. He believed that corrections would be made if parents understood the 
reasons for the recommendations, and that a nurse should be available to visit 
the parents at home and explain why care was needed. 

A few municipalities and school boards were employing school nurses, as 
noted previously, and Dr. Young concluded from the questionnaires and from 
the reports of the nurses that the school nursing system should be expanded. He 
also believed that such a system would be the first step towards a more compre- 
hensive community public health nursing system. 

The Public Conscience Awakens After The War 

Another important factor favoring the introduction of public health nurses, 
which Dr. Young later pointed out in an address to the Canadian Public Health 
Association in 1 928 was the "awakening of the public conscience." He stated that 
prior to World War I (1914-18) "the voices of public health authorities were 
crying in the wilderness. The public was not concerned. Epidemics were consi- 
dered visitations from providence." Health authorities had been largely con- 
cerned with sanitation. The public was appalled to learn that one third of the 
Canadian army recruits had been rejected as unfit. The health of the young 
which should have been at its peak was found wanting. The war had shown that 
general health measures had prevented outbreaks of disease, as well as demon- 
strating the benefits of good health and medical care. The public was now in a 
mood to accept advice in health matters, and at the same time health authorities 
had broadened their scope to include general health protection, advice, and 
preventive health measures. 

The New System of Public Health Nursing 

Dr. Young believed that with the awakening of the public conscience after the 
war, it was now time to find a system of improving general health, and he 
proposed to start with children. By improving the follow up of the medical 
inspection program to include family health teaching, he hoped to improve the 
health level of the general population. This meant the employment of someone 
educated in public health work and understanding preventive measures. Dr. 
Young concluded that the logical person to do this was a nurse trained in public 
health. Such nurses were rare, and in British Columbia, non existent, as nurses at 
that time were trained for curative work which did not include prevention. Dr. 
Young developed a broad plan which would encourage the application of known 



health information and improve the general health of the people ol Bnti»h 
( olumhia I hi* plan was to he the foundation of the prevent das public health 
vers 

l)r ^ Oling'l plan involved two main ohjcclivcv I he lirvt was lo establish an 
educational program which would equip nurses lor puhlic health district work. 
and the second was to vet up health centres throughout the prov iruc Irom which 
I lies would work 

I he nurses would he known as puhlic health nurses, and thc> would be 
"generalized" 01 what l)i Young termed a "single nurse " I hat is. the public 
hcallh nuiscs would not he limited to one spccihi. area ol health, such as working 
with schoolchildren or with tuhcrculosis patients, hut would be equipped to deal 
with the general health problems ol all members ol the lamilv and the 

community 

I he health centres were 10 be set up in local districts, and a health committee 

or board representing various groups in the community would be established to 

assist the public health muse and to administer the service 

I he I irsl ( nurse fur Puhlic Health Nurses ( ommences at 
I he I nisrrsits <if British ( olumhia 

I >i N OUIIg set about establishing B public health nursing training emir seat the 

I niversity "i British Columbia which he had helped lound in 1908 He was an 

influential figure on the campus as he had been instrumental in getting the 

l niversily established when he was the Ministei ol Education. I hen too. with 
i in- u.i i over, the Red Cross was looking for worthwhile projects to iponsoi I h 

^ oung was able to interest them in funding the lust course foi a period ol three 

years I he Red Cross, Bl that tune, decided to set up eight nursing stations in 

remote parti ol the province which would employ graduates oi the course 

B\ ls»|°. the Department ol Nursing and Public Health was established on the 

old I Bin icw Campus ol the University ol British Columbia, and Dr. ^ oung's 

idea was undei wav as the hi si public health nursing course lor registered nurses 
commenced li was the lust in Canada and the British i mpire' I he diploma 
course was fourteen weeks when it stalled and later was extended to a lull 
academic yeai I ectures Were On the campus, practice was arranged in selected 
areas and held trips to appropriate places were arranged as part ol the learning 
experience I he nurses were prepared to Work in a community setting and deal 

with cur rent health problems Hie first class graduated in 1920 and helped form 

the nucleus ol the newly established public health nursing service 

\s the demand lor public health nurses increased, the Bachelor ol Applied 
Science in Nuising program was added and in 1923 the hrst three nurses 
graduated I his program provided students with the opportunitv to quahlv as 
registered muses and to obtain a Bachelor ol Applied Science degree I he lirst 
two \eais ol this program were given at the university lollowcd bv twentv eight 
months ol hospital training aflei which the nurse completed registration as a 



nurse in British Columbia. The Vancouver General Hospital entered into an 
agreement with the university to provide the practical experience. The nurses 
were fully recognized graduates of the Vancouver General Hospital. A final year 
of study at the university completed the six year program which then qualified 
the nurse for a B.A.Sc degree. Another option was made possible later which 
granted a B.A. degree to nurses who completed three years of academic program 
upon graduation from the hospital. The total program was comprehensive, 
fitting the student to meet organizations, and carry out health programs as they 
related to health education and teaching. 



10 



II. THE PROSPEROUS TWENTIES 



11 



The Prosperous Twenties 

The twenties brought a period of unprecedented prosperity in British Colum- 
bia. Industrial growth had come to the province and with it improved financial 
times. In the aftermath of World War I, the interior mines were prosperous and 
pulp and paper was being produced in the mill towns of Powell River and Ocean 
Falls. Expanding markets had stimulated the lumber industry. The Canadian 
merchant marine was shipping all over the world. Great quantities of wheat were 
being shipped through the harbor of Vancouver. Employment was at a high level 
and everyone was making money. 

The old Cariboo road was rebuilt and became the first important road link 
between the mainland and the Okanagan. 

The influence of the mountains which created large valleys was apparent as 
the people of these valleys developed rather special regional characteristics 
rather than a provincial uniformity. The type of life and the background of the 
early settlers influenced their life style. One found quiet, well-read ranchers in 
the Okanagan, miners in Kamloops, vigorous outdoor people on the Cariboo 
ranches, fishermen in the Skeena and farmers in the Omineca, who lived differ- 
ent life styles but showed a common interest in improving their situations. 
Vancouver had become the great metropolitan city of the province containing 
about one third of the total population. It was an aggressive materialistic city 
which could not entirely dominate the rest of the province which demonstrated 
more varied interests and outlook. Because of these differences, one can under- 
stand how health services developed in each part of the province. 

The decade of the twenties was a good time for people to consider new ideas 
and to learn how to improve health. It was therefore possible for Dr. Young, the 
Secretary of the Provincial Board of Health to make a good start on his plan for 
developing health centres and public health nursing districts, and eventually to 
establish some public health units. 

The Public Health Nursing Service Commences 

As the population of the province neared half a million, the first health centre 
was established in 1919, in Saanich, which is a rural municipality adjoining 
Victoria city. It was known as the Saanich War Memorial Centre, and financed 
through local taxes and grants from the Provincial Board of Health. Miss Jessie 
Foreshaw was appointed as the first public health nurse. 

The same year, Miss Barker was employed as a district nurse in Cowichan, 
while plans for the establishment of the Cowichan Health Centre were being 
worked out. In 1920 the Cowichan Health Centre was established at Duncan and 
Miss B.E. Hall, a qualified public health nurse was appointed. 

In 1920, the Rural Esquimalt Nursing District with headquarters in Langford 
was formed with Miss Helen Kelly the first public health nurse. 

By 1921, the University of British Columbia had graduated 56 public health 



12 




Saanich War Memorial Health Centre officially opened in 1921. 



nurses from its program and 1 5 had been placed in rural settings. Three had been 
recruited in Saanich but records do not indicate where the remainder were 
employed. Seven were appointed to either Red Cross demonstration districts 
such as Kamloops or to stations which were providing district nursing service in 
isolated districts such as East Arrow Park, Creston, Vanderhoof, Fort Fraser 
and Waldo. Some were employed in Vancouver as school nurses and with 
agencies such as the Victorian Order of Nurses etc. By 1920 the provincial public 
health nursing service had become a reality. 

Public Health Nursing a Success 

The public health nursing service made a good beginning. The public health 
nurses had been given a sound basic education, and were generally enthusiastic 
young women who responded well to the people in their districts and also fitted 
into the professional and social life in their communities. They were well 
accepted and held in high regard because of their personal and professional 
abilities. They were able to introduce new ideas concerning public health, and to 
point out ways of improving the health of the people in their districts. The public 
health nurses set the stage for the expansion of public health services which 
would eventually lead to broader and more diversified health services to be 
provided later through health units with fulltime medical health officers. 

New Incentives to Stimulate the Organization of 
Public Health Nursing Districts 

In 1921, another step forward in the financing of public health nursing 
districts came when the Department of Education agreed to provide to a local 
district the same grant for a public health nurse as for a teacher. This new grant 
plus the grant from the Provincial Board of Health provided most of the funds 
needed to employ a public health nurse who could be employed either as a school 
nurse or a district nurse. As a district nurse she would have a generalized 
program and look after about half as many school children as the school nurse. 

To help small rural schools obtain a public health nursing service, a number of 
schools were permitted to "group together" to form a nursing district which 
would be large enough for one public health nurse to serve. At that time each 
school district in a rural area had its own school board, while in a large city area, 
all the schools were administered by a larger school board. A school board in 
unorganized territory was the only agency that could levy a tax over the exact 
area of the school district, so it was a logical organization to represent the people 
of the district. 

The "grouping" of small school districts to form larger districts suitable for a 
public health nursing service was the beginning of plans for sharing the costs of 
health service for the common good. It provided another incentive to encourage 
the development of new public health nursing districts. For example, in 1 928, the 
Kelowna Rural Schools Health Association was formed to employ a public 



14 



lealth nurse in a district with twelve small school boards. 

Before a district could be established it was necessary for an organization to be 
let up locally so that funds could be obtained to establish a budget to cover the 
:ost of the service. Usually the initiative was taken by an organization such as the 
Women's Institute, a school board or the Red Cross. A local health association, 
:ommittee, or board was then formed to be responsible for administering the 
ervice. It represented the special interests of the local people. Fixed provincial 
irants were available from the Provincial Board of Health and the Department 
»f Education. The British Columbia Tuberculosis Society usually gave yearly 
;rants decreasing in amount over four years. Local funds which made up the 
ialance of the budget were received from local school taxes and grants from 
irganizations and clubs. The public health nurse was employed by the board, 
nd had been recommended and approved by the Provincial Board of Health. 
he board looked after local expenses which consisted of her salary and trans- 
ortation costs as well as office and other costs. The public health nurse 
ubmitted a monthly report when she appeared at the regular meeting of the 
oard. The board gave her the needed support to conduct her various activities 
l the district. 

lealth Centres and Nursing Districts Commence 

The health centre and nursing district concept was to provide a generalized 
ublic health nursing service for all the people in a designated geographical area, 
lealth centres were to be established in large population districts, while nursing 
istricts were to be set up in more rural communities. The basic generalized 
ublic health nursing service was to be similar throughout the province, 
Ithough the manner of providing the service would vary with local conditions, 
he service provided was to be administered by a local health board, association 
r committee, while technical and professional advice was to be provided by the 
rovincial Board of Health. The boards would be made up of individuals 
presenting organizations which had helped sponsor the service, and with 
horn the public health nurse would work, such as the Women's Institute, Red 
ross, I.O.D.E. (Imperial Order of the Daughters of the Empire) etc. When 
nancial support came from the school board, it was also represented. When the 
nancial support came entirely from the school board then the school board was 
le advisory health committee. 

The first two health centres were established on Vancouver Island in Saanich 
id in Cowichan. Both provided buildings with good living quarters, office and 
inic space. Saanich had six hospital beds for about four years for special tonsil 
inics, special treatments etc. The public health nurses lived in the health centres 
id paid for their room and board. This money helped employ a housekeeper 
ho also provided a telephone answering service for the nurses when they were 
isy working in their districts. The public health nurses were on call twenty-four 
)urs as the service included home deliveries and home nursing. 



15 



As the health centres became known, the nurses were asked to help in all kinds 
of emergencies. They often found themselves acting as a crisis centre. Also 
people would bring them old clothes and garden produce for distribution to the 
poor which they did in their free time. The arrangement to have the public health 
nurses live in the health centres was very satisfactory at that time, as private 
accommodation was hard to find, also all public health nurses were single and 
there was no need to provide accommodation for husbands or children. It was 
the custom for a nurse to resign on marriage. 

As nursing districts were located in smaller population areas, the public health 
nurse did not as a rule work out of a "Health Centre." She used the best possible 
place available to her for her work and in many instances used her own home 
which was frequently a small cottage. Her home then became her headquarters 
where she stored her confidential records and had her telephone. When the 
public health nurse was a "boarder" messages were relayed to her by the landlady 
who usually was most helpful. She often was able to fill in the background on 
callers! In some communities such as Langford, a single nurse district, the public 
health nurse worked from her home which was called a health centre. 

The Esquimalt Rural Nursing district boasted in its 1 922 annual report that it 
had the most economically run health centre on Vancouver Island or perhaps in 
all British Columbia. They pointed out that "all other health centres had 
headquarters to keep up, either a building, or equipment, or necessary offices 
rooms and equipment. 'Nightingale' the name of the home of the nurse in charge 
at Colwood is used as the professional headquarters of the service, where minor 
accidents are attended to, dressings etc., when not done at the home of the 
patient, and here also the telephone calls for the nurse are taken and booked. A 
comparison of overhead expense with other health centres will show the advan- 
tage with regard to expense." Needless to say, the public health nurse was the 
major subsidizer of the centre. 

School nurses employed by school boards usually had quite satisfactory 
medical rooms set aside for them in the schools. Also a limited amount of clerical 
work and message taking was provided through the office of the school 
principal. 

How the Public Health Nurse Operated (Office, Clinics, etc.) 

The operating expenses of the public health nursing service consisted mainly 
of salary and travelling costs. Free office space was usually supplied in one of the 
schools. For work in the school, the public health nurse used a medical room or a 
class room, or the teacher's lunch room. A corridor might be used for vision 
testing. Classrooms were frequently used for community health clinics, when 
parents would come to the local school with their small children and infants. At 
times, community or church halls were made available for clinics usually at no 
charge. However the public health nurse might have to get a wood stove fire 
going to warm the building. Privacy was rare, although screens were used. Most 



16 




Cowichan Health Centre — Duncan 1927 



often the public health nurses laundered the linen at home. 

Special pieces of equipment such as baby scales were donated by an organiza- 
tion such as the I.O.D.E., or borrowed from the local drug store. For many years 
to come public health nurses had inconvenient, poorly heated office quarters, 
located in the cheapest available space. They usually "made do" so that a service 
could be established. 

Travel through the district presented problems. For example when the first 
public health nurse was appointed to Cowichan, she used the daily train service 
which was unsatisfactory. Then the Health Committee bought her a bicycle, 
which improved the situation. Finally the Red Cross bought a second hand car 
for her use. The above situation continued into the thirties as Miss Dorothy 
Priestly reported in 1973 when the new modern health centre was opened in 
Prince Rupert: 

"I was the first public health nurse in Prince Rupert, called a school 
nurse by everyone but myself. I arrived on Sept. 1st, 1937 and was taken to 
the City Hall where I was greeted with a small pair of foot scales, and one of 
the old black record books, quite empty. They were happy that I had all the 
equipment I needed to start with these two things. An office to work in 
never entered the picture, or a car. Well what would I need a car for? From 
that time, I scrounged a little space here and there when school opened. 
Never did I get transportation and I walked for 5'/£ years." 
The same story with variations existed throughout the province as public 
health nurses gradually became established, starting in a very humble way. 

The Early Record System 

There was no well defined method of keeping records or setting up files at this 
time. The public health nurse used the school medical records as a starting point. 
These records were kept in the school and contained the results of the school 
medical inspector's examinations. The public health nurse carried a small black 
book with classroom lists on which she had recorded pertinent data to use for 
home visits etc. The school medical record was transferred with other school 
records by the school principal when the child moved to another district. The 
public health nurse set up individual records which she also carried for infants, 
preschool children or adults being supervised or receiving service. Her records 
on all tuberculosis patients were sent to her from the Supervisor of Tuberculosis 
Nursing when each new case was diagnosed. The nurse did her own clerical 
work. Letters were handwritten unless the public health nurse could type. Then 
she used her own typewriter. She usually used her own stationery and stamps 
too. However these were not great expenditures as there was little correspon- 
dence. (Stamps were three cents.) 

The system was fairly simple, but required the public health nurse to keep her 
records up to date. This system remained until the early forties when the general 
record and the family health record were introduced. 



IS 



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GENERALIZED PUBLIC HEALTH W5/ffi 









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Public Health Nursing display, Cowichan Health Centre — Duncan 1925 




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Public Health Nursing in the Twenties 

Detailed reports of the public health nurse's work in Cowichan and Duncan 
were published in the annual Provincial Board of Health Reports in 1923 and 
1924, which serve as examples of the type of program being carried out there as 
well as elsewhere in the province. 

As could be expected, activities were directed towards the major health 
problems of the day — the high infant death rate, contagious diseases, malnutri- 
tion, rickets and poor sanitation. Emphasis was placed on teaching personal 
hygiene and general health practices. The following activities were noted in the 
reports: 

• All new babies were visited at home, and followed by monthly visits to help 
teach mothers the best way to feed and care for their babies. 

• Infant well baby clinics — were held either at the health centre or in the most 
suitable place in the district. The public health nurse weighed and measured the 
baby and advised the mother on care. At periodic intervals local physicians 
volunteered their services to examine the babies. Those needing further medical 
care were referred to their own physicians. 

• Monthly letters on child care as prepared by the Federal Government were 
sent to the mothers. 

• Preschool children received a similar service at clinics but were only followed 
up for a particular problem. 

• School children — Schools were visited regularly, and the public health nurse 
inspected all the children in each classroom for contagious diseases and skin 
conditions such as impetigo, scabies, as well as head lice. She weighed and 
measured the children monthly, gave health talks, encouraged children to make 
health posters, inspected school sanitation (water containers and privies) and 
carried out other special activities. 

• Little League courses on child care were held in the schools for girls ages 10 
— 14 years. Successful students received a badge and certificate from the Provin- 
cial Board of Health. 

• Special clinics were organized for chest X-rays, Eye and Ear examinations, 
Tonsils and Teeth. Some were held in the health centres. 

• Home Nursing course for adults — a twelve week course was offered with 
successful candidates receiving a certificate from the Provincial Board of 
Health. 

• Health Teaching — was done for individuals and groups. Talks were given, 
posters displayed, and educational exhibits set up at fall fairs etc. Available 
literature on personal hygiene and diet was distributed. 

• Nursing Care in the home — This service was offered in most centres on 
Vancouver Island. This was a 24 hour service including maternity and home 
deliveries. A small charge was made. Many people at that time carried a 
Metropolitan Life Insurance policy which included a limited number of free 
visits. The company was billed for these visits. 



20 



N> 




Arrival of some ol the babies. Saanich War Memorial Health Centre 1922 



to 




Ready to depart. Infants and Preschool children. Saanich War Memorial Health Centre — 1922 




<b^ 'i-.Hi; -j ., f 






yV" 



Sludenis nl I mlc league Mother's Classes Saanich 1922 



• Contagious Diseases Homes were visited, families shown how to isolate 
the patient and carry out quarantine regulations. Homes with communicable 
diseases were placarded by the medical health officer with large colored signs 
that read "Diphtheria". "Scarlet Fever" etc. 

• 1 uberculosis Patients at home were visited regularly when they were given 
supplies such as sputum cups and bottles for sputum tests. X-rays arranged, and 
the patient and family advised on the progress as well as the recommended care 
of the patient. 

• Transportation Few people had cars, and the public health nurse often 
found it necessary to take patients to a physician or hospital. 

• Goitre There were goitre areas in the province, where preventive treatment 
was given. The school medical officer ordered iodine tablets which were given 
e\ cry day for six months under the supervision of the nurse. In 1929 five percent 
of all children had goitre problems. However in Kamloops it was 1 1.5%, Revel- 
stoke and Kootenays 11%, whereas Vancouver and Vancouver Island had a 
lower rate ol 2.5' V . The problem was not solved until iodi/ed salt was introduced 
in the early forties. 

The Public Health Nurses' Bulletin and Selected Reports 

The Public Health Nurses' Bulletin was published each year from 1928 to 1939 
by the Provincial Board of Health. It was intended to inform the public health 
nurses of progress being made in the development of the public health nursing 
service in the pro\ ince. Each public health nurse submitted a narrative report on 
a subject of her choice. These reports give a very good insight into the commun- 



is 



ity involvement of the public health nurses in the development of better health 
care. A number of excerpts are quoted to illustrate the work in this period. 

Public Health \ursing Program — For Every One in the Family 

It is sometimes hard to translate programs into people and actions taken 
to improve a health situation. Here is how Miss H. Kelly P.H.N, worked 
through what she called her "social service" program. This might have 
other names now — Mental Health, Rehabilitation. School Health etc. 

"In a large district, such as the one in which I am operating as nurse in 
charge of the Esquimalt Rural Nursing Service, the service necessary to 
bring about the desired results of educating the people to a realization of 
the benefits derived from supporting such a service in their midst is very 
varied. 

Apart from the usual aims and objects of a Public Health Nurse, which 
include the dissemination of all information tending to check the spread of 
infectious and contagious diseases, and the inculcation of habits of right 
living amongst the people, child welfare, etc., social service must play a 
very important part in the daily life of a nurse in charge of such a service. 

If all the work accomplished by a Public Health Nurse could he made 
public, there would be no difficulty in obtaining the vote of the people at 
the annual ratepayers' meetings for the extra small assessment towards the 
upkeep of the service in their midst, but much of her work has of necessity 
to be kept confidential, and therefore much of the benefits of the service are 
known to only the few. 

I will quote one case of many, withholding, of course, names and 
anything which may lead to identification, whereby the Slate has been 
saved, potentially, many thousands of dollars; the State, and thereby the 
people. 

The case deals with the Social Service Branch of the work. I learned of a 
family living away back in the bush, where there were three boys who, 
owing to them living outside the 4-mile limit, had never attended school. 
Accompanied by the vicar of the parish, I went to investigate the case. 
Taking my little car up miles of rough trail with barely room at times to 
pass, we eventually located the place where the family in question were 
living. There we found a shocking condition of things in general. The three 
boys, ages 6, 8, and 10, had not only never been inside a school, but were 
unable to speak properly, owing to the fad that the father was almost 
stone-deaf and the mother on the verge of a mental collapse through 
loneliness and lack of association with her fellow-creatures. 

Within two weeks we had the family moved to the village of--, and very 
soon after that had collected sufficient clothing for the boys to attend the 
school there. This was some months ago, and the boys are now doing well 
at their studies and show fine promise, and the mother, though still 



24 



suffering more or less from her terrible experience of loneliness in the bush, 
shows great improvement, and no reason at all why she should not become 
a normal healthy woman. The father, a good workman, but severely 
handicapped by his extreme deafness, will have the chance to become a 
useful self-supporting citizen, as I succeeded in interesting the local 
Women's Institute and the Nursing Association to the extent of procuring 
an ear-trumpet for him. 

That is only one case from one portion of the district; but it will serve to 
show how necessary it is for a Public Health Nurse, when in charge of a 
district, to give and have a wide view of the opportunities of service, and for 
the people to realize this service and support it liberally, and thereby save 
themselves increased taxation in the future. It will not require a very vivid 
imagination to realize what a burden such a family would have become to 
the State eventually had they been left to their own devices." 

Helen Kelly. P.H.N. Colwood Public Health Nurses' Bulletin. Oct. 1924 

Public Health \ursing Program — Health Teaching in a Rural School 

Miss Isabelle M. Jeffares. public health nurse, reported as follows in the 1924 
Public Health Nurses' Bulletin, on how she had assisted teachers with their 
health teaching by means of a health book competition and playlet: 

Cowichan Lake School Pair 

I had accepted an invitation to attend the School Fair at Cowichan 
Ijike, our most rural school, about 20 miles from the Health Centre 
headquarters, and present the prizes for the Health hook Competition, 
which were given by the Provincial Board of Health. Cowichan Lake 
School is in the centre of a logging community and most of the children 
come from the different camps. 

On arrival at the school we found the judges were busy in the school 
house with the exhibits, and sports in progress on the grounds; a group of 
about forty parents being accommodated on roughly put up benches or on 
the desks from the school house. 

In the school house the different exhibits were arranged attractively, our 
interest, of course, being centred on the "Health Books." Last February it 
had been suggested to the teacher that, if she cared to take the matter up, a 
prize would be given for the best essay, poster, or book on any health topic- 
taken up by the School Nurse during the term. About eighteen books and 
several posters were sent in competition; some of them were a great 
surprise. The majority of the books were illustrated with cut outs, while 
some had little pencil or water colour sketches, all of them being made to 
look as much like a book purchased in a shop as possible. One clever little 
book on " Milk" had an amiable looking cow on the front cover and a very 
tiny milk bottle in the centre of the back cover. 



2^ 



After the sports had been run off and the judges had completed their 
task, the pupils put on a little health playlet, in which there was paraded 
before a little, pale, thin "City Boy" all the good things he could procure 
more easily by living in the country. The children were dressed to look the 
part of the article they represented; for instance, "Egg" was a tiny golden- 
haired girl, carried in a large basket covered with white crepe paper. When 
all the "Good Things" were arranged around the little boy and he was 
considering their real value, in walked a procession of his old-time "Ene- 
mies, " headed by a large "Coffee-pot, " and followed closely by "Pie" and 
"Candy." It was not very long, however, before the superior strength of 
"Milk" and his faithful supporters was felt, the "Enemies" chased afar off, 
and thin, little "City Boy" left to his new friends." 

Isabelle M. Jeffares, P.H.N. Duncan 

A Public Health Nurse's Comments on Her Work in a Rural District 
— Keremeos 

"It often seems hard to believe that so much can take place in a space of a 
few years. Before I went in training most of my life was spent in outdoor 
work and as the hours flew by I dreamed many things. One of these was to 
become a nurse and go about doing good, helping people who were in 
trouble, etc. When our community first had a District Nurse I used to envy 
her unendingly and think of the wonderful opportunities she had for doing 
good. As soon as possible I trained at the Vancouver General Hospital, 
took the Public Health course with field work at Saanich Health Centre, 
and came back to my community to do Public Health Nursing. I find it is 
not quite so simple, and, try as I may, I cannot recognize in myself the 
District Nurse of my dreams. I always liked the people here, which was one 
of my incentives for coming back to them, but since I've been working 
among them I appreciate them more than ever. 

Before leaving the Coast I was talking to a prominent doctor, who stated 
that he considered it a pity to do District Nursing, where what I had 
learned would only fall to disuse. I only wish I could see him now, as I 
would have better material for argument, as I'm sure if he spoke to our 
local doctors, who by the way are miles distant, he would change his 
opinion. One must be ready for any emergency, and in serious cases such as 
pneumonia, where the patient can't be taken to hospital and the doctor can 
only come every second day, there is a great responsibility. 

One of the things that makes District Nursing here a pleasure is the 
co-operation of the doctors. Nothing is too much trouble for them, and 
when in doubt over some small illness, where the patient feels they can't 
afford to have the doctor, if I phone the doctor, he is only too pleased to 
explain the best course to take. 

I find the school-work very interesting and pleasant; the children are so 



26 




Insignia pin worn by Public Health Nurses in the 20 s and 30 s 



27 



enthusiastic, especially the little ones. I find their interest greatly stimu- 
lated by giving small prizes for health chores, etc. At Christmastime, with 
the help of the primary teacher, we put on a health play, which was very 
successful. I would like to mention here that the teachers are a wonderful 
help to the nurse, and that it is greatly appreciated. The percentage 
underweight has improved since last September from 60 per cent to 48 per 
cent, at the present time. I held a tonsil clinic early in November for the 
school children of Keremeos and Cawston. There were eight children 
operated on, and I have been very pleased to see the marked improvement 
in the children since then. One of them gained 4 lbs in a month, and they 
have not been home from school with colds as in previous winters. I started 
on February 1st to give a series of talks and demonstrations in practical 
nursing to a class of Canadian Girls in Training in Cawston, and later I 
started classes in Keremeos for girls from 14 to 20. These classes are well 
attended and the girls seem interested in the work. " 

Patricia East, School and District Public Health Nurse 
Public Health Nurses' Bulletin 1927 

Public Health Nursing Uniforms and Insignia 

The first public health nurses wore a distinctive blue uniform to indicate that 
they were district community nurses in contrast to hospital nurses who wore 
white. They wore plain tailored bright blue shirt waist dresses in the style of the 
early twenties. The skirt was just above the ankle, the dress was belted with long 
sleeves, trimmed with white starched or celluloid collars and cuffs. A slim black 
tie was worn with an official "pin." 

As the provincial government had recognized the public health nursing service 
as an official service of the government, Dr. Young was able to secure permission 
to have the British Columbia Government insignia incorporated in the official 
pin. It was a small round blue and gold pin with the government crest in the 
centre in gold with "Public Health Nursing" lettered in gold in the cobalt blue 
border. This pin continued into the thirties. 

There was no official coat or hat at that time although most of the public 
health nurses wore blue berets or felt hats. 

The school nurses did not wear a special uniform although some wore their 
white hospital uniforms, or white coats over civilian clothing. 

The Public Health Nursing Service Grows in the Twenties 

The first public health nurses were well received in their districts. The local 
people generally appreciated the work being done, and word of this new service 
gradually spread to adjoining communities. The Provincial Board of Health 
began to receive requests to start similar services in other parts of the province 
and so the service gradually expanded. The fact that the public health nurse was 
also a school nurse, and for all children, whether rich or poor helped provide an 



28 



to 




Public Health Nurses. Miss Isabelle M. Jeffares (Cribb), Miss Esther Naden (Gordon), in front of the Cowichan Health Centre - 1926 



easy entrance to all the homes in the district. This was one of the greatest factors 
in making the public health nursing service acceptable to everyone in the district. 
The concept of a public health nursing service for all was new but most accepta- 
ble because of the way the service was organized. Also the educational back- 
ground and enthusiasm of the newly appointed public health nurses was an 
asset, as they were generally outgoing persons dedicated to developing services 
which would benefit the health of everyone in the district. 

The Public Health Nursing University Course Becomes a Requirement 

In 1 928, the Provincial Board of Health ruled that all nurses working as public 
health nurses must have completed a university course in public health nursing 
to be eligible for permanent employment either as a school or public health 
nurse. All applicants for positions in the districts covered by the Provincial 
Board of Health had to be approved before grants were paid to local school 
boards or health associations. As a result the local services turned to the 
Provincial Board of Health to fill a vacancy, or to find a public health nurse for 
them when one was needed. A very close liaison developed between the Provin- 
cial Board of Health and the local health service. Dr. E. Young, Secretary of the 
Provincial Board of Health recruited public health nurses directly from the 
University of British Columbia, interviewed prospective candidates, and 
arranged their employment. He required the public health nurses to send him 
monthly narrative and statistical reports so that he would know of the progress 
being made in the various districts. This included a special report on the service 
in the schools which was forwarded to the Department of Education to justify 
payment of their grant. The policy of qualified public health nurses only for 
public health work had a great influence in the future development of public 
health in the province. 

The First Move Towards Full-Time Medical Health Officers and 
the First Health Unit 

As public health nurses became more involved in community health work they 
found health related problems which they could not solve alone. It became 
apparent that there was a need for a full time medical health officer to direct and 
co-ordinate the health service. All communities had part time medical health 
officers either appointed by the municipality or city, or by the Provincial Board of 
Health in unorganized territory. School boards had part time medical inspectors 
who were local physicians. In many instances the two part time positions were 
held by the same physician. Although the system provided for some needed 
services, particularly in emergency situations, it did not generally work too well as 
far as the conduct of routine work or health planning was concerned. The 
physicians had little or no training in public health as their interest and education 
had generally been directed towards the treatment and care of sick people. Patient 
care naturally came first with the result that planned public health clinics, or 



30 



school visits with the public health nurse, frequently had to be cancelled because 
of medical emergencies. Many were too busy to give the time needed to this part of 
their work which did not particularly interest them. The public health nurses 
wasted much time waiting for them for clinics, waiting for appointments etc. 

Dr. Young was of the opinion that full time medical health officers should be 
appointed, and in 1927, he was able to convince Saanich Municipality to use 
funds normally allocated for part time assistance such as the school medical 
inspector and medical health officer, and employ a full time medical health 
officer who would be responsible for all health matters in the municipality. Thus 
the first health unit was formed in Saanich in September 1927, when Dr. David 
Berman was appointed. His staff consisted of two public health nurses, two 
school nurses, and a clerical assistant. Some sanitary health inspection services 
were made available through the municipality. It was the first rural health unit 
and a similar organization became the objective of districts in other parts of the 
province. 

There is some difference of opinion on the use of the term "health unit." The 
question arises as to whether the term should apply to an area with funding from 
only one local source such as a municipality or whether the term correctly 
applies to a geographical area or unit composed of more than one local govern- 
ment. However, Saanich Health Unit is generally considered the first provincial 
health unit. 

The Twenties Introduce the Health Unit Concept 

The Saanich Municipal Health Service with its full time health officer and 
public health nurses working out of a health centre proved to be effective and 
efficient. New ways were considered to provide a similar type of service to 
smaller communities. Smaller population clusters in rural areas lacked a tax 
base, which presented difficulties in raising sufficient funds to employ the well 
qualified staff that larger centres could afford. At the same time, the smaller 
number of people could not justify the funds for full time staff. Thus the concept 
of smaller communities joining together to form a health unit which could share 
the cost of employing qualified public health staff for the benefit of everyone in a 
designated geographical area, or health unit was developed. 

The South Okanagan was an excellent area to introduce the health unit 
concept, when Dr. G.A. Ootmar, in 1928, was appointed full time Medical 
Officer and Sanitarian in Kelowna City, and Medical Officer and School Medi- 
cal Inspector over a large unorganized territory (100 square miles). The unit 
included Kelowna City which appointed its school nurse, Miss Frances Leyne, 
and a School Medical Inspector, Dr. W.J. Knox, and the area served by the 
Kelowna Rural Schools Health Association which employed Mrs. Anne Grin- 
don as a public health nurse to serve the district in which twelve rural schools 
were located. This set up formed the Kelowna Health Unit which became the 
first health unit to demonstrate that a rural and city area with different forms of 



31 



local government could join together to provide a good health service. 

Both health units eventually were to be reorganized to cover more municipali- 
ties, cities, villages and unorganized territory so that they would be truly local 
provincial health units. The Kelowna Health Unit was reorganized in 1940, to 
become the South Okanagan Health Unit. In 1948, Saanich became the Saanich 
and South Vancouver Island Health Unit, later being reorganized as the Greater 
Victoria Metropolitan Board of Health (1961) and finally the Capital Region 
District Community Health Service (1973). 

Tuberculosis Nursing Supervisor for Public Health Nurses 

Tuberculosis continued as the first cause of death among infectious diseases 
during the twenties and was therefore a major health problem. In 1921, there 
were 521 deaths from tuberculosis when the population was only 524,000. The 
Provincial Board of Health accordingly took over the main responsibility for the 
treatment and care of tuberculosis patients. Active cases of tuberculosis were 
admitted to provincial tuberculosis hospitals for treatment, to learn how to care 
for themselves, and also to limit the spread of the disease. Suitable patients were 
permitted to return to their homes and communities to be supervised then by a 
Travelling Medical Officer, Tuberculosis Specialist, and the local public health 
nurses. 

The Provincial Board of Health established a community service for tubercu- 
losis control which provided clinics for patients and their contacts, held at 
periodic intervals throughout the province in the larger population centres. At 
these clinics, X-rays and other tests were taken, examinations made and medical 
advice given. The public health nurse followed up the patients by visiting them at 
home, advising them on personal care, infection control etc. A central registry of 
all known cases and contacts was established at the headquarters of the Tubercu- 
losis Division in Vancouver. As tuberculosis was an infectious disease, advice 
and guidance was made available to private physicians as indicated, by the 
Travelling Medical Officer, and by a specialized Tuberculosis Nursing Supervi- 
sor. Generally the local physicians left the management of tuberculosis to the 
health service. 

Miss Josephine (Jo) Peters was the first nurse to hold this position, after her 
initial employment by the Rotary Clinic in 1 92 1 to help the public health nurses 
in the Vancouver area. In 1924 she was appointed by the Christmas Seal 
organization to work with Dr. A.S. Lamb, Travelling Medical Officer and first 
medical tuberculosis consultant for the province charged with supervising 
patients living outside institutions. Miss Peters was appointed Travelling Nurse 
to accompany Dr. Lamb to his clinics, take X-rays, and to advise public health 
nurses on the management of patients and their contacts. In 1937 she was 
appointed Supervisor of Tuberculosis Nursing and continued to assist field 
nurses until her retirement in 1948. She kept in touch with the public health 
nurses so that they could instruct patients on the care being recommended as 



32 



each new case was diagnosed, and when the condition of patients changed. On 
initial diagnosis she sent the local public health nurse the green record known as 
the P.H.7., which contained pertinent information such as the diagnosis, time 
for next sputum test, X-ray etc. This system proved to be excellent as treatment 
at that time was mainly limited to good personal hygiene, adequate rest, and 
regular examinations which were essential to determine the course of the disease. 




Josephine Peters at her retirement cottage. Yellow Point. Vancouver Island — 1949 



33 



III. THE DEPRESSION YEARS - THE THIRTIES 



35 



The Depression Years — The Thirties 

The prosperous twenties came to a close with the New York stock market 
crash of 1929 which was the forerunner of the great depression of the thirties. Its 
effects were felt in far off British Columbia as the economy came to a standstill. 
Businesses retrenched, cities and municipalities cut budgets and eliminated 
many services. Money became scarce as fewer people were employed. "Unem- 
pjoyment Insurance" did not exist, and Social Assistance which was then known 
as "relief was limited to severe hardship cases. Many families broke up as men 
began to ride the rails across the country in search of seasonal or any kind of 
work. The government finally established work camps for men, mainly in the 
interior of the province, where they were usually occupied with road work. 

It was a time when many people could not pay for medical or hospital care. As 
a result they were reluctant to visit or call a physician except in the most dire 
circumstances. When physicians were used they were often paid in kind by 
garden vegetables, butter etc. The need for health care and medical treatment 
was great but few people could afford private care. Most people hospitalized 
were "ward" care or non-paying patients. 

Public Health Nursing in the Depression 

The public health and school nurses responded to the depression as best they 
could. They carried on with their regular programs and set about organizing the 
people in their districts to help the less fortunate according to their situations. 
They interested organizations and clubs in providing money for persons in 
special need of treatment and care such as eye examinations, glasses, layettes, 
camps for the undernourished, tonsil and adenoid removal clinics (there were no 
antibiotics at this time and many badly infected T&A's). They distributed used 
clothing, cod liver oil samples etc. 

The following report from the Peace River Health Unit indicates how one area 
worked out its plan for a tonsil clinic with limited finances and the help of the 
staff: 

Tonsil Clinic in the Peace River Block 

"The tonsil clinic was in full operation upon my arrival in the Peace 
River Block. It has proved a very successful method for the removal of 
diseased tonsils among the children here. 

Following the regular examination of the school children, it was appar- 
ent that some were affected with diseased tonsils which were detrimental to 
the health. Parents in many cases had been informed of these conditions, 
and except in a few cases had not taken any action. Reasons for this were 
due chiefly to the characteristic conditions of this part of British Columbia. 

The majority of people live on homesteads, some of which are a very 
long distance from a doctor or hospital. Often the only means of travel is 



36 




Dorothy Tate (Slaughter), Muriel Smith Heather Kilpatrick, P.H.N.. Cowichan Health 
(Dann), P.H.N.'s — Saanich 1934 Centre — Duncan 1935 




Isabel McMillan (Staples), Florence Barbaree 

(Graham), Nancy Law, Healther Kilpatrick, 

P.H.N.'s, Cowichan Health Centre — Duncan Anna Larson (Mason) P.H.N. — Maple Ridge 

1937 1938 



37 



by learn, and at limes travelling is practically impossible due to poor roads 
and climatic conditions. Also, on the other hand, during the good weather 
both men and teams are busy on the land. 

Many parents also feel they are unable to meet the added expense which 
would be entailed in such work. They are really trying to build a home from 
the beginning, which is typical of pioneering, and they really need their 
finances for the maintenance of themselves and children. 

Another reason, although it may not always be a major one, is lack of 
knowledge of hygiene and the way to maintain health. Time, money, and 
mind have been occupied with building a home and making a living. The 
people do not realize the value of practising all the health rules, nor know 
that tonsils can be detrimental to health in that they are sometimes the 
forerunners of serious diseases such as rheumatism and cardiac conditions. 
However, through the efforts of the staff of the Health Unit, many parents 
are learning the value of health rules put into practice and are more ready 
to cooperate. 

Because of these difficulties it was decided that a different plan must be 
put into effect, in order that the work could be done successfully on a large 
scale. The chief aims were to have the defects corrected and to make no 
distinction between the economic conditions of the people whatsoever. An 
arrangement was made whereby a special flat rate was to be paid to cover 
the hospital and doctors' fees. For the few who were unable to pay the full 
rate, arrangements were made that they could work out the balance on 
various schools where there is a certain amount of work to be done such as 
painting and kalsomining, repairs, moving of privies, and also putting in 
the year's supply of wood and ice. 

Following the completion of these arrangements, the members of the 
health staff interviewed the parents, advising them of the need of the 
removal of the diseased tonsils and adenoids. From those parents who 
were in favour of the work they obtained a written permission from them, 
and also made arrangements for payment, to be either in full or part cash 
and part by working. 

The clinic was held during July and August of 1937. The children were 
transported to and from the hospitals by members of the health staff. 
Following the return of the child home, the parents were instructed regard- 
ing the post-operative care, as the majority of the children remained in the 
hospital for a day following the operation. Usually, within the next week, 
and another home visit to note the progress of the child, and to give further 
instruction, if necessary. The mothers seemed to appreciate these follow up 
visits, as they felt the Health Unit was sharing the responsibility of caring 
for their children by giving the needed instruction. 

One of the greatest factors in the operation of this clinic was the 
distances that had to be covered in transporting the children. At times trips 



38 



from 70 to 95 miles were made. In some instances the parents co-operated 
and brought their children to a central point where they were met by a 
member of the staff. On one of these trips, which was made partly by boat, 
members of the staff and two children spent the night on a sand bar in the 
Peace River. They fell little the worse for their experience, however, except 
for lack of sleep, and looked upon the night 's outing as one of the episodes 
that made life in the Peace River Block varied. 

Tonsillectomies were advised in 147 cases and 138 children had their 
tonsils and adenoids removed, showing how successful the first tonsil clinic 
in the Block proved to be. The results are manifesting themselves, as there 
is improved health among these children. In one case, a boy has gained 12 
pounds and is now taking a keener interest in his health. Thus through 
clinics and other means, the Health Unit is trying to teach people of the 
Block that "an ounce of prevention is worth a pound of cure." 

Kathleen Shepherd, P.H.N., Rolla. 
P.H.N.'s Bulletin, March 38 

Immunizations were still urgently needed to protect the public from certain 
contagious diseases so that the public health nurses set up clinics for protection 
against diphtheria, scarlet fever and smallpox, whenever and wherever they 
could be arranged. In some locations where local physicians attended baby 
clinics the public health nurses were permitted to give the injections but not 
vaccinate for smallpox. Vaccination for smallpox was required before a child 
could attend school unless parents could prove they were "conscientious objec- 
tors." Free biologicals were supplied to physicians by the Provincial Board of 
Health, and parents were encouraged to have their children immunized by their 
own physician or at a public health clinic. However as physicians charged a fee 
for each injection the cost was prohibitive for most families. Because of the 
availability of the public health clinics in the local school and district clinics, the 
community protection level was raised in those districts where public health 
nursing services were available. 

The majority of public health nurses worked alone, as only four health units 
had been established up to the thirties, and these were much smaller than the 
present day units. Most of the public health nurses worked in single nurse 
districts and were assisted by a part time medical health officer who was also the 
sanitary inspector. The part time health officers usually had busy practices and 
had little time available for preventive work. Usually they were willing to help 
with specific problems brought to their attention, but they did not provide 
general leadership in the development of health programs or facilities. 

The excellent results of the communicable disease program of education and 
immunization was pointed out by Dr. Young in his 1934 annual report when he 
stated that the death rate from scarlet fever, measles, whooping cough and 
diphtheria had dropped from 58.9 in 191 1, to 7.4 per 100,000 population in 1933. 



39 



At baby clinics the emphasis was on health teaching of child care. No treat- 
ments were done and conditions needing medical attention were referred to 
physicians. The public health nurses visited in the homes to ensure that proper 
care was given. 

The public health nurses were generally expected to be available at all times, 
and were frequently called in the evenings or at weekends. They were often asked 
to decide whether a physician should be called. Few people had telephones or 
cars, and public transportation was non existent except in big cities. Taxis were 
not available in many small towns. Public health nurses found themselves 
spending a good deal of time transporting sick children home from school, to the 
doctor, or hospital. At that time it was the only way that many could get needed 
care. 

Report from an Isolated District on Vancouver Island — Sayward 

My District Work, Past And Present 

" Well nigh ten years have passed since I was first appointed as District 
Nurse in Sayward, although prior to that I had on many occasions been 
called upon to assist, in times of need, settlers and loggers in this vicinity. I, 
as a qualified nurse, was sought in cases of emergency, and felt glad on 
those occasions that I was able to lend my assistance to those so sorely in 
need. But upon being officially appointed I discovered the unpleasant fact 
that many of the settlers did hot look upon my work at all favorably. This 
was especially true in regard to the supervision of the school children, the 
installing of sanitary appliances and improvements in the little buildings. 
However, there is nothing like perseverance to win a cause; now the 
schools are equipped with water filters (which were most decidedly 
needed), individual drinking cups, medicine chests, and proper sanitary 
outhouses. Last, but not least, I have won the co-operation of parents and 
School Boards. 

This district is still very much in the pioneering state, being isolated by 
the lack of road connection with the rest of the island. Only the bi-weekly 
visit of a Union steamship keeps this scattered district in touch with the 
outer world. Therefore very few changes have taken place in my ten years 
of service. 

For the past four years Dr. Youlden, dentist, has been sent in by the 
Provincial Board of Health and attends the school children and tiny tots. 

For the past five years the Coast Mission ship "Columbia" has carried a 
doctor on board. They touch in here about every two weeks, and on very 
urgent occasions can be reached by wireless. Co-operation with the Mis- 
sion workers is a great help in serious and hospital cases. One case in 
particular I well remember: it was when a miner was badly mangled by an 
explosion. Three days after the accident, which took place far up in the 
hills, the " Columbia" docked at Alert Bay and our patient was removed to 



40 



the Mission hospital, where he was immediately operated upon. But 
unfortunately help of this kind cannot be always at hand and we must 
make the best of things and do the best we can. 

The prenatal work is carried on as far as possible, and I must add a word 
inpraise of the postnatal letters, which are certainly most helpful to young 
mothers in isolated places. 

Two years ago a little cemetery was opened in Sayward, in which there 
now lie five occupants. It is one of my duties as District Nurse to lay out the 
corpse. 

In summing up my work, it is this: Prenatal work; bringing into this 
world little lives; care of children and their various ailments; accidents; 
sickness; and, last of all, watching through the long hours of the night as 
the grim reaper takes his toll. 

There is likely to be much development going on in Sayward during the 
coming years, as a very large logging camp is making arrangements to start 
operations in the valley. This will make a great deal of activity in the 
district and serve to bring in more settlers, which will add considerably to 
the range of work in this district. 

Edith M. Walls, R.N., Sayward 
Public Health Nursing Bulletin 1933. 

Gradual Expansion in the Thirties 

During the thirties, in spite of the poor financial situation, a number of 
communities decided to employ either a public health nurse or a school nurse. 
The number of public health nurses in the province gradually increased as new 
public health nursing districts were formed in communities such as Port Alberni, 
the Peace River, Dewdney, Nelson, Chilliwack, Maple Ridge, Abbotsford etc. 
The number of nurses being prepared for public health nursing at the University 
of British Columbia kept pace with the demand. 

The work of the public health nurses was being recognized as pointed out in 
1 934 in Dr. Young's Annual Report. "The public health nurses have been one of 
the bright stars of our work. The Board of School Trustees of British Columbia 
introduced a motion at their annual meeting to make the establishment of public 
health nursing mandatory throughout the province." The recognition which the 
public health nurses received was encouraging as they usually worked alone in 
districts under difficult conditions and did not always appreciate the impact of 
their work. The following report explains how one public health nursing service 
began: 

First Public Health Nursing in the Peace River (Report) 

"On to the Peace!" is the slogan that has been drawing many new 
residents to this part of the country. The writer journeyed five months ago 
into the Peace River District, being sponsored jointly by the Red Cross and 



41 



the Provincial Board of Health. The Peace Block is a vast rolling country, 
with huge cut-hanks gouged into it. The hanks are covered with golden 
birch. Patches of stubble surround the clearing of the homesteader. There 
he lives in a little log cabin, often with only a dirt Poor. His nearest 
neighbour is a mile away at least, usually farther. 

I have charge of twelve schools and their districts, scattered over moun- 
tains and along the banks of streams, in an area of 120 square miles. 
Transportation is difficult, as the weather is likely to change unexpectedly 
from 60 below to above zero. The roads may be lost beneath heavy snow 
and ice, or submerged beneath floods of water. The thick gumbo is almost 
impossible for a car, and is bad even on a horse. 

Last week I had to take a maternity case into Pouce Coupe, to the Red 
Cross Hospital. It is only 40 miles and the roads had been cleared of snow 
for the mailman, who comes through once a week. I keep my car 3 miles 
from where I live because of the bad drifts. It was necessary to harness my 
team and in the open cutter drive to the place where my car is kept. Picking 
up my patient, we drove into Pouce Coupe in the car. It had started to snow 
before we turned homeward, but by pushing ahead we managed to get 
back within 8 miles of my home, when the car stuck in the snow in afield. I 
had to walk 2 miles back in a real blizzard to the home of one of my 
committee-men, who drove me to my own team. The drifts were so bad by 
this time that we could not keep to the road. We upset three times into the 
snow in weather 60° below zero! We were lost in a woods with which 1 am 
perfectly familiar and could not find the gateway to our own place. It was3 
a.m. before we reached home. Just a day's work in the Peace! 

The work as a whole has taken a great hold on the community. I have 
twelve committees, one in each district. Each has a representative on the 
Central Committee, which meets once a month. They work hard and are 
taking a keen interest in public health matters. They all want to help 
toward the development of health services in other parts of the country in 
time to come. 

This is a country of no water, unless you are lucky enough to live near a 
creek or river. This presents a real problem to the school trustees, as well as 
to the parents, to see that there is a sufficient water supply to meet the needs 
for both drinking and washing. Since most of the water comes from the 
melted snow and ice, we have started giving iodine to many of the school 
children to prevent goitre. This is done under the direction of our school 
doctor. 

The most interesting event was the "family" clinic which I ran in five 
districts. Each family was taken as a unit and all the children — infant, 
preschool, and school — were examined by Dr. Becworth. Many of the 
mothers travelled long distances to reach the clinics, where they were 
greeted by members of the committee who assisted with the weighing and 



42 



the taking of records. The mothers took a great interest in the whole 
programme. For many of them it was their first trip in years farther than a 
few miles from their homes. We are planning to complete all twelve 
districts in this way and should have some interesting statistics when we are 
through. 

I hope that the day will soon come when we have more Public Health 
Nurses up here. There is much to do. People are gradually filling in all the 
farm lands. This part of the country has wonderful prospects and a 
fascination all its own. But, like all the Northland, it is a stern master and 
demands stamina and courage in all those who choose to settle here. In a 
land where all the news and messages travel by "moccasin telegraph" and 
neighbours are scattered, a real community spirit of helpfulness and 
patience must develop. " 

Nancy E. Dunn, R.N., Rolla 
Public Health Nurses' Bulletin 1932. 

Getting Around in the Thirties 

Some of the public health nursing committees purchased cars for the public 
health nurses to use in their work. This occurred particularly when home nursing 
service was provided. In 1936 a standard Ford cost $865.50 according to the 
Cowichan Health Centre Report of that year. A special Provincial Board of 
Health grant of $500.00 was given to help with this purchase. 




- - - '■■■:■ .:::■? i^?$^,m%i?.-? 

Jennie Hocking, Marjorie Sutherland, Muriel Smith (Dann), Esther Naden (Gordon). Saanich 
P.H.N.'s - 1934 



43 




Alice Bcattie. P.H.N.. Cowichan Health Centre Duncan 1939 

However, in those days cars'were neither reliable nor comfortable. Mrs. 
Geraldine Langton (nee Homfray) a former public health nurse at Duncan 
recalls how the public health nurses used to take along hot water bottles and 
wrap themselves well in quilts for night trips. At that time cars did not have 
heaters, and were open to the air. When it rained, isinglass (similar to clear 
plastic) curtains were fastened on with domes. (Zippers had not been invented). 
Snow tires were for the future, but chains were in use. Mrs. Langton relates that 
she had no car when she transferred to Chilli wack and had to travel by "Shanks' 
Mare," so she tried a bicycle without much success. Then she bought a car and 
the school board agreed to pay her $15.00 per month to use the car for work. She 
served a large rural farm district. 

As might be expected in the Peace River, horse and sleigh or cutter were used 
on some trips while some public health nurses used a horse to make their rounds 
a good part of the year. Boats, too, according to this ditty 



"Transportation." 

"I'm writing a ditty, 
About a nurse in a city. 
She starts in the morning 
Hopes of health restoring 



44 






In the course of her travels 
She gets stuck in the mire 
Or, what is much worse 
May have a flat tire. 

Her arms waving wildly 
To people who pass 
She hopes they will help her 
And offer her gas. 

At night while on duty 
If the telephone rings. 
She wonders who it is 
As she grabs up her things. 

She jumps in her car — 
The night's black as pitch 
She steps on the gas 
And goes in the ditch! 

On leaving the car 
She climbs in a boat 
And then does her best 
To keep it afloat 

When at last with her patients 
All night she has tarried 
She drags herself home 
And decides to get married." 

V. F. & D. T. Saanich Health Dept. 

A solution for everything! 

The Generalized Service Established as Best 

During the thirties the generalized public health nursing service was firmly 
established as the best method of community health nursing service. This 
decision was reached following trials in various districts. For example, in 
Nanaimo the generalized system was tested against the specialized school sys- 
tem. The following report by Miss Maxine Morris (Dunn) in the 1939 Bulletin 
explains the findings: 

"The public health nursing service successfully completed a six month 
trial to find out whether a generalized service by each of two public health 
nurses would be preferable to the previous system with the school public 
health nurse limiting her work to school children and giving some assist- 
ance at well baby clinics. In the new system each nurse provided all the 
service in her own district and this proved to be best." 
The generalized system was used in the new demonstration health units 



45 



started in the thirties and in the new districts being organized, with the results 
indicating that this system was best, both from the community's and the public 
health nurse's point of view. 

New Health Units in the Thirties 

Three demonstration health units were financed jointly by the Provincial 
Board of Health, the Rockefeller Foundation, and the local district. The first 
was set up in 1930 in North Vancouver, followed by the Metropolitan Health 
Committee Unit in 1937 which included Vancouver City and the rest of Burrard 
peninsula; then the Fraser Valley Health Unit was established in 1938 for the 
Matsqui-Sumas-Abbotsford area. The Peace River Health Unit was established 
and paid for by the Provincial Board of Health in 1935. Elsewhere, the public 
health nurses carried out the generalized public health nursing service and set the 
pattern for new districts and health units to be developed later. 

It is interesting to note that the health officer and staff of the Peace River 
Health Unit worked from their homes, as there was no common office. 

The following ditty tells how the work in the Peace River Health Unit 
progressed: 

A Ditty From The /Worth 

"In B.C.'s Peace River Country 'tis scarce three years ago 
We started our Health Unit here amid the frost and snow. 

People said it wouldn't prosper, ' Wait till 50 below, ' 
or 'Mud of the Peace River Country just won't let car 
wheels go. ' 

Our first Director, Dr. Cull, a very wise young man, 
Said to his public health nurses, 'Let's get busy while we 
can. 

We'll gel to know these people. We'll immunize them all, 
And to round up mumps and measles, we'll always be on call. 

We'll examine all school children. I'm sure we're elected 

To find their defects and their ilk, and then get them corrected. 

Our duties are many, our handicaps great. 
There's hard work ahead — let's blame it on fate. 

The weather and mud is as bad as they told us, 
And now my good nurses, let nothing dare hold us! 

We've immunized the people against all that we can, 

And now they're asking for more — Such are the ways of man! 

Teeth and tonsils have had a share of close attention 

And other problems we've checked off — too numerous to mention. 



46 






Three years we have been striving and our unit stands true, 
Schemes and plans for further service, spur us on to work 
anew. 

Of course our staff has changed a bit. Dr. Cull has gone away. 
Some of our nurses left us, Dr. Hershey's come to stay. 

These are our ways of travel: by boat, by sled, by car. 
On horseback, in a wagon. Sometimes on foot we are. 

The weather's really not so bad when you dress in proper togs. 
Mud roads can be conquered — why just chop down some logs! 

Most residents greet us with smiles and pleasant words, 
In the local vernacular we're really 'not bad Birds. ' 

We carry on the same old job we first set out to do. 
There's something in it has allure. I'm sure you'd feel 
it, too. 

So if you'd like some Public Health work to prevent your 
getting blue 

Come up to the Peace River Country. She'll put a spell on 
you!" 

Rita M. McFarlane P.H.N. 

Public Health Nurses' Bulletin, March, 1938. 

More Health Protection Needed 

The 1930 s were notable as a time when public health nurses concentrated not 
only on nursing problems, but attempted to interest the people in their commu- 
nities in more general health control measures such as better sanitation, pure 
water, milk etc. 

Sewage disposal was very primitive, particularly in rural districts. Pit privies 
were common at homes and schools. Public water supplies were raw. Provincial 
rural electrification had not been completed. Many schools and homes still used 
kerosene lamps. Refrigerators were not in common use even in cities. Chlorina- 
tion of water supplies, pasteurization of milk, improved sewage systems were 
some of the community needs. Public health nurses tried to interest the public in 
supporting the introduction of new preventive health measures. They talked of 
the need for full time health services which would include a full time medical 
health officer and a sanitarian. They tried to explain the need for more compre- 
hensive health protection. 



The First "Refresher Course" 

The need to keep up to date was recognized when the first "Refresher Course" 



47 



was held in 1923 on the campus of the University of British Columbia organized 
by Miss Ethel Johns, the Director of the University Public Health Nursing 
Program. It was arranged with the Provincial Board of Health as a three day 
meeting to assist the public health nurses with their field programs and to 
provide them with an opportunity to exchange ideas. As the first Refresher 
Course was successful, similar courses were arranged annually until 1939. This 
st> pe of educational program commenced again in 1941 under provincial auspi- 
ces and was renamed "The Public Health Institute." 

Dr. H. Ksson Young Directs The Public Health Nursing Service 

Dr. Young employed the first public health nurse in 1919 and continued 
during his time to interview, accept or reject, and place public health nurses as 
requested by the local health committees or school boards. As he was keenly 
interested in how each public health nurse was progressing, he required a 
monthly written report of her activities. He would frequently telephone for 
clarification, and send back his comments. By the late thirties he was over 
seventy-five years of age and found it increasingly difficult to keep up with the 
greater numbers of public health nurses and the expanding work of the Provin- 
cial Board of Health. He began to plan for a public health nursing director to 
take over the responsibilities of the nursing service. 

The Need for a Public Health Nursing Director 

About this time, public health nurses began to feel the need for assistance of a 
public health nurse in an advisory position from the Provincial Board of Health. 
Miss Madeline Putnam (Werts) wrote in the 1939 Bulletin "There is a need 
for a generalized field supervisor to set standards and develop a uniform ser- 
vice." As can be imagined, each public health nurse set her own standards and 
emphasized the areas she felt needed attention. Often she worked hardest at the 
programs which she liked and from which she derived the most satisfaction, 
sometimes limiting or not giving other services. For example, she could spend 
most of her time with school children and have limited time for visiting new 
babies. As the number of public health nurses grew, the need for more advice and 
guidance from a nursing consultant on the staff of the Provincial Board of 
Health became evident. By this time too, a nursing supervisor was advising the 
public health nurses on the tuberculosis program and they were frequently 
seeking help from various members of the nursing faculty at the University of 
British Columbia. This was no longer sufficient and plans were in the making. 



48 






Public Health Nursing Variations in the Thirties 

As the thirties drew to a close, public health nursing service was available in 
the province in a variety of ways. They included: 

(1) Health centres, such Saanich and Cowichan, and Nursing Districts such as 
Langford and Qualicum provided a generalized service including school, 
home nursing and maternity services. This type of complete service was 
confined to Vancouver Island. 

(2) Public health nursing service — Most rural areas such as Kelowna Rural, 
Nanaimo Rural, and Chilliwack District provided the generalized service 
which included school nursing. Home nursing was on a short term and 
demonstration basis. 

(3) School health nursing service — provided in many larger cities and towns 
such as Victoria, New Westminster, Kelowna, Penticton, Fernie, Nelson, 
and Nanaimo. 

(4) The Victorian Order of Nurses, a national organization, utilized provincial 
grants to assist in financing a few branches where they provided generalized 
health service in addition to their usual bedside nursing service at Oliver, 
Gibsons and Westbank. In Victoria and in the Vancouver area they also 
provided some infant health care. 

(5) The Red Cross — public health nurses operated out of Out Post Hospitals, 
and gave some community service in some areas where there was no resident 
physician. In 1921 there were nurses at East Arrow Park, Waldo Malakwa, 
Kamloops, Vanderhoof, Creston, Fort Fraser and Mt. Olie (North Thomp- 
son). They also supplied a home nursing service in New Westminster. 

(6) Indian Health Service — The National Department of Health and Welfare 
provided a generalized public health nursing service on the Indian reserves 
of the province, (except for a small number served by provincial public 
health nurses). 

(7) The Vancouver Metropolitan Board of Health provided public health nurs- 
ing service in its area, while the Victoria Order of Nurses provided the home 
nursing service. 



49 






IV. THE FORTIES - 
THE WAR YEARS AND AFTERMATH 



51 



The Forties — The War Years And Aftermath 

I hree major events brought the thirties to a close and affected the continued 
development ol public health and public health nursing in the torties. 

I he lirst was the death in 1939 of Dr. H Esson Young, the Secretary ol the 
Provincial Board ol Health and Provincial Health Officer, after a distinguished 

career in the health field For ovei thirt\ years. During his tune he built the 
foundation for public health and became known as the "fat her ol public health in 
British Columbia." Dr. Young was succeeded by his protege. Dr. (iregoire F. 
\m\ot. who had set up the demonstration health unit in North Vancouver, and 
returned from the American Public Health Association in the Tinted States to 
accept the appointment. Dr. Amyol was in agreement with Dr. Young's plans 
which he proceeded to develop. 

The second major event was the appointment of Miss Heather Kilpatrick as 
the first Director of the Division of Public Health Nursing which had been 
established in 1939. 

The third major event was the Second World War which began in September, 
1939. and stimulated the economy and the way of life in the province so that it 
would be forever changed. With the war on. the depression was soon over. 
I'ncmplovment ceased as men and women joined the military services or worked 
in war- related industries. The war provided not only financial relief for the needy 
but also opportunities for many to learn new trades, to travel and become 
exposed to life outside their own narrow villages, towns, and cities. 

The war. too, affected public health nursing. As the war progressed, more 
physicians joined the services and public health nurses were reminded that they 
were the "home front," and expected to remain to help the civilian population. In 
fact, in the early years of the war, recruiting officers gave a very low priority to 
public health nurses so that very few made it into the military services. The 
public health nurses manned the "home front," providing needed health services 
for those left at home. As part of their war effort they increased the number of 
home nursing and first aid courses to enable families to become more self reliant 
in their new situation. 

Population Growth in the Forties 

During the forties, the population increased by 42%. The 1941 Census had 
gnen the population as 8 1 8,000, and during the following decade it increased to 
over a million ( 1, 165,000). The greatest percentage population increase was in 
the north and in the interior of the province. The Peace River increased by 
67.2* i . the Cariboo by 57.7%, and the Okanagan by 50%. The increase was due 
to settlement brought about by improved and new roads as well as generally 
improved transportation. This unprecedented population increase led to short- 
ages of medical, nursing and other professionals to fill the need for service. 
particularly in the outlying parts of the province. Training facilities in the 



52 







Heather Kilpatrick, the first Director of Public Health Nursing — 1940 

province were inadequate so that more and more persons from outside the 
province had to be recruited to fill the need. This was true for public health 
nurses as well as institutional nurses. 

The First Public Health Nursing Director 

Miss Heather Kilpatrick R.N., B.A., B.A.Sc. was appointed as the first 
Director of Public Health Nursing in September, 1940. She proved to be an 
excellent choice, as her quiet capable manner inspired confidence in her co- 
workers and the public health nurses. She was an experienced public health 
nurse, having worked as a staff nurse and supervisor in the Cowichan Health 
Centre at Duncan. A graduate of the degree program in Public Health Nursing 
at the University of British Columbia, she had completed the post graduate 
course in Administration and Supervision at the University of Toronto, as well 
as a travelling fellowship in which she had studied a number of public health 



53 



nursing programs in the United States. Her post graduate studies had been 
sponsored by the Provincial Board of Health to help prepare her for this 
important assignment. She was welcomed by the public health nurses! 

The Division of Public Health Nursing Gets Inder Way 

Following her appointment. Miss Kilpatrick set about expanding public 
health nursing services into new areas of the province. She met with interested 
organizations such as local branches of the Women's Institute and school boards 
to tell them how to go about organizing public health nursingdistricts. While she- 
was Director, ten new districts were established and a number of existing 
districts extended to include new areas. 

Another of her objectives was to expand existing school nursing services into 
full community public health nursing services. As the Provincial Board of 
Health had the authority to approve new public health nursing appointments. 
no new school nurse appointments were approved. Currently employed school 
nurses were encouraged to expand their program to include community services. 
However, a certain amount of resistance occurred. Most school nurses worked 
the same hours as school teachers, but the latter had a shorter day and work 
week, two months summer holidays, plus long Christmas and Easter vacations 
while public health nurses were working six days a week, with fewer holidays. 
However most school nurses gradually added preschool children to the immuni- 
zation program and started some well baby clinics. 

Miss Kilpatrick had reviewed the work of the public health nurses on field 
visits, and believed that the time had come to shed some of the non-nursing 
activities such as transporting sick children home from school, distributing 
clothing to the poor, giving out free samples of vitamin pills etc. Also the number 
of routine school inspections and weighings no longer seemed necessary as 
nutrition and hygiene had generally improved. 

The Provincial Board of Health had planned that the Director of Public- 
Health Nursing would administer the public health nursing service and that four 
consultants would supervise and guide the work of the public health nurses in the 
field. During the forties the goal of acquiring four consultants was not reached, 
but by 1943 it was possible to appoint two excellent public health nursing 
consultants. Miss Dorothy late (Slaughter) and Miss Helen Carpenter. Both 
consultants had very good backgrounds of experience in public health nursing 
plus additional University preparation in Administration and Supervision in 
Public Health Nursing. 

The Public Health Nursing Director and consultants visited the public health 
nurses in their districts to learn at first hand about their problems and difficul- 
ties Besides viewing the district, they usually met with the local public health 
nursing board or committee members to discuss administrative matters. Discus- 
sions frequently centred on such items as transportation costs, who should 
provide the nurse's car, office or clinic space, clarification of the role of the 



54 




Residence and office of Marjorie Staniforth 
(Wisby), P.H.N., at Progress in the Peace River 
- 1942 



Marjorie Staniforth (Wisby), P.H.N. Progress. 
Peace River, home visiting — 1943 




Kelowna Public Health Nurse carries baby scales from clinic at Winfield Hall — 1941 



55 



board, as well as policies with regard to specific programs such as the enforce- 
ment of the Communicable Disease Regulations, reporting of communicable 
diseases etc. They were able to provide guidance and support to the public health 
nurses and would refer special problems to appropriate members of the Provin- 
cial Board of Health. At that time there were very few agencies in British 
Columbia which provided assistance to children with special physical or mental 
problems. However the consultants were able to assist the public health nurses to 
solve most of their local difficulties. 

The addition of the two public health nursing consultants to the staff of the 
Division of Public Health Nursing provided Miss Kilpatrick with more time for 
administrative planning. At that time there were 41 public health nursing 
positions in the provincial service. 

Public Health Nursing News and Views 

A monthly newsletter, "Public Health Nursing News and Views" was started 
by Miss Kilpatrick in 1941 to provide a vehicle for the exchange of information 
between public health nurses and to foster the feeling that all the nurses belonged 
to a province-wide organizaticn in spite of the fact that many worked alone. 
Besides items of educational and practical value inserted by its editors, there 
were many interesting contributions from the public health nurses. Personal 
news such as marriages, new appointments, new districts and resignations kept 
the staff up to date. "News & Views" was a mimeographed bulletin which 
replaced the earlier printed Bulletins established in the 1920 s. The Division of 
Public Health Nursing edited and compiled the monthly publication until it was 
taken over in 1950 by the Division of Health Education as a medium of 
communication for all field staff. "Public Health News and Views," as it was 
then renamed, was a most valuable publication which documented provincial 
policy changes, introduced new record forms, reference material etc. It was 
discontinued in 1976. 

Travel in the Forties 

By 1940, the public health nurse's use of the cars owned by the local health 
committee or school board had become contentious. It was wartime, gas was 
rationed and cars were not readily available for purchase. The nurses' cars were 
sometimes seen being driven on the weekend and coming from their homes by 
persons not familiar with the public health nurses' working hours. As there were 
very few health centres or main offices, much of the public health nurse's work 
was conducted from her home. Also "the car" was usually garaged by the public 
health nurse for security reasons, and to save storage charges. Most of the public 
health nurses would have preferred to drive their own cars for work but there 
was no provision for this possibility. However by 1941 a new policy was 
established which allowed the public health nurse to be paid a flat rate of $35.00 
per month to drive a car for work. This new policy was a mixed blessing as it 



56 




Marjorie Staniforth (Wisby), P.H.N., on the 
way to quarantine for mumps. Progress, Peace 
River— 1942 



Pauline Yaholnilsky, P.H.N. — Quesnel 1940 s 



worked well for a public health nurse in a compact district with good roads such 

as Kelowna city, but not for the public health nurse with a spread out rural 

district with poor roads, who could not break even because of engine failures, 

need for more new tires etc. Also this policy worked against recruitment. Few 

public health nurses could afford this luxury after completing a university 

program. Also nurses were in short supply because of the war. By 1 945 the policy 

was again changed and the Provincial Board of Health began to supply cars to 

the local districts. 
One should not pass the forties without comment on some of the problems of 

the day — cars, roads, and accommodation. As noted previously, in the early 

days the public health nurses covered their districts on foot, by bicycle, rail, and 

horse. In the forties as immunizations and other clinical programs expanded the 

public health nurse needed more equipment with her to conduct her daily work. 

This included the nursing bag, immunization supplies such as a portable stove, 

gas for the stove, syringes, needles, pots for boiling, records, scales for weighing 

babies etc. The public health nurse needed all these items when she set out on a 

visit to one of her districts where she would visit a school, hold a clinic and make 

some home visits all in one day. A car was a necessity. Contrary to common 

belief that in the old days cars were better built, the fact is that cars were 

generally unreliable, especially in bad weather, they shook apart, tires easily 

became flat, and the ride was generally rough and uncomfortable. One could say 

that the old style cars had some advantages, as Mrs. Bertha Thomson, public 

health nurse at Keremeos discovered. She had been accustomed to fording the 



57 



Similkameen River in an old beat-up car with a high clearance, and in 1 942 when 
it was finally replaced with a sleek new low-slung model, the smart new car 
couldn't make it across the river and she had to go the long way around! 

The main highways outside the lower mainland were mostly unpaved "wash 
board." The local roads were very narrow dirt roads. Not only was the driving 
rough but vision was obscured in summer by clouds of dust and flying gravel. 
There were few service stations or public telephones so that when the car broke 
down, or got stuck, the public health nurse was on her own. Farmers were kind 
and were usually agreeable to getting a team of horses to pull the nurse's car out 
of the mud. In the Cariboo and the North there was the dreaded "gumbo" of 
spring break up and fall freeze up when roads were impassible. Ferries with 
limited sailings crossed lakes and rivers which today have good bridges like those 
at Nelson, Kelowna and over the Peace River. 

Then, too, there were situations which required special ways of getting there. 
For example Miss Pauline Siddons recounts how in 1 952 she had to travel in an 
ore bucket up Hedley Mountain to the top of the mine, and return later with the 
ore bucket nearly full. She was always afraid they might dump the bucket before 
she jumped off! Public health nurses grew accustomed to riding the "scooter" 
over the rails when returning to Squamish from a visit to the Pemberton Valley. 

In a few isolated districts the public health nurse was depended upon for 
transportation in an emergency. For example: 




Marjorie Staniforth (Wisby), P.H.N. Progress, 
Peace River — 1943 "Gumbo" 



Marjorie Staniforth (Wisby), P.H.N. Progress, 
Peace River — 1943 



58 



Miss Marjorie Staniforth (Wisby) healed at Progress in the Peace River 
recounts in 1943: "Just as I was about to get supper a call came through the 
only phone in the district. It was an excited grandmother who said her 
daughter was about to have a baby. I dashed to my cottage across the street 
from the store where the phone was, grabbed the maternity outfit which I 
had supplied myself with and kept in sterile bundles for such an emergency, 
as I lived 23 miles from the nearest hospital. My district covered a large 
area 20 to 40 miles in different directions. A t night we had no phone 
connection to any doctor, but I could be reached at any hour day or night. 
Someone was always in the store or their house which was attached had a 
telephone extension and they would come over with a message. The roads 
were very muddy with deep ruts. One had to be careful not to fall into them 
as it was easy to break an axle. I covered the 15 miles as quickly as possible. 
As I drove up, the grandmother stood there ringing her hands. I stopped 
the car and called, "How often are they coming?" I had no idea if I had got 
there on time, or if I could possibly take the patient 15 miles to the hospital. 
The grandmother said, "Every three years!" I wondered why 1 had rushed. 
Of course, she meant children, not pains. As it turned out, I was able to get 
her to the hospital with the stork flapping its wings close behind." 



Overnight accommodation was where you could find it. Miss Staniforth 
relates how she travelled with the School Inspector and the Medical Health 
Officer, Dr. J. A. Taylor to Moberly Lake in late January in 40 below (F.) 
weather. They went as far as they could by car, then changed to horse and wagon 
to cover the last 15 miles over frozen ground on a narrow road, spent the night in 
an unused school where they built a fire, and slept in their outdoor clothes in 
sleeping bags. In the morning they hiked back a mile to the Hudson Bay Post for 
breakfast, then set up a clinic, which was attended by every family in the district. 
Notice had come by "runner" the previous night. Providing public health 
nursing throughout the various parts of the province required ingenuity and 
stamina. 

Study Groups for Public Health Nurses 

Miss Heather Kilpatrick encouraged the public health nurses from adjoining 
districts to come together for monthly study sessions or group meetings. The 
sessions were usually held on Saturday morning, which was part of the work 
week, as the five-day week had not arrived. Pertinent public health topics were 
discussed at these sessions. In the early days it was not possible for groups to be 
formed in all areas because of the limited number of public health nurses and in 
some instances the travel distance between districts was too great, being 100 or 
more miles over poor roads. 



59 




I'.H.N.'s following a Study Group Meeting on Vancouver Island — 1948 

However, the public health nurses on Vancouver Island and the Okanagan 
and Kootenays met regularly. As the numbers of public health nurses increased, 
more groups were formed. Usually they met in a central location, or they might 
take turns visiting various districts. Working time was used for the meetings, and 
personal time for the return trip home which was often a number of hours. 
Favorable comment on the subjects and contributions of the following regional 
groups was made by Miss Dorothy Tate in 1945 in her annual report. 

Vancouver Island — Simplification of record forms 

Fraser Valley — Revision of Prenatal Letters 

East Kootenay — Simplification of Sanitation Problems 

Okanagan — Special Reports 

Peace River — Clarification of Personnel Policies and Educational Facilities. 

Gradually as more health units were formed in the late 40 s and 50 s and more 
public health nurses were employed, health units were able to form their own 
study groups. The meetings were usually held in conjunction with the health unit 
staff meeting when health unit policies and programs were discussed. 

The study groups served a useful function, contributing to ongoing education, 
assisting with the development of general policies, and also serving as a way of 
keeping the public health nurses working well together. 



60 



The Public Health Nursing Council 

When the public health nurses attended the first Institute meetings in 1941 and 
1942, there were rumblings of discontent about such matters as salary levels, 
insufficient car allowances, lack of pension plans, etc. Miss Kilpatrick believed 
that the best way to bring these matters to the attention of the Department was 
through approved resolutions from the group. In this way individual nurses who 
might raise problems at a general session would not be singled out as trouble- 
makers or agitators. Therefore on April 22, 1943, at the Institute, a special 
meeting of public health nurses was called, and chaired by Miss Isabel Louks 
(Foster). At this meeting the Public Health Nursing Group was formed, with 
Miss Alice Beattie elected as first chairman and Miss Joyce Leslie the first 
secretary. At this meeting a representative committee was formed "to stimulate 
discussion and draw up plans for future Institutes." Six members were elected to 
represent the regions as follows: 

Fraser Valley — Miss Dorothy Priestly for 16 public health nurses. 
Okanagan Valley — Miss Lucille Giovando for 9 public health nurses. 
East Kootenay — Mrs. Joanne Brewster for 4 public health nurses. 
Peace River — Miss Marjorie Staniforth for 4 public health nurses. 
Vancouver Island — Miss Alice Beattie for 16 public health nurses. 
Cariboo — Miss Eileen Snowden for 2 public health nurses. 
In all they represented 51 public health nurses. In 1944, the group became 
known as the Public Health Nursing Council. Some of the early activities 
included the circulation of professional journals and the organization of 
regional "study groups." They submitted suggestions on the need for more 
literature on immunizations, the need for procedure manuals, medical insur- 
ance, pension plans, travel allowances, etc. 

A "Uniform Committee" was formed in 1945 representing all areas, advisory 
to the Director. It met annually at Institute time, and generally conducted 
business by correspondence. 

In 1948, the first constitution and by-laws of the Public Health Nursing 
Council were passed, and were amended in future years as the organization 
developed. At first verbal reports from the regions were presented at the annual 
meetings which were in time replaced by written reports. The regional represen- 
tatives became "the Executive" which held a special meeting prior to the general 
session. These were long meetings at which resolutions were deliberated well into 
the night. 

As problems concerning various record forms were frequently raised at Coun- 
cil meetings, a Public Health Nursing Records Committee was set up in 1950, 
chaired by Miss Monica Frith, Director of Public Health Nursing, with repre- 
sentative public health nurses and Mr. John Doughty, Director of the Division 
of Vital Statistics. The Committee met monthly to approve new records, revise 
or delete others, and to establish the flow of records. The first meetings were held 
in Abbotsford. As the Department grew and more records came into use this 
committee was reorganized as the Provincial Records Committee in 1957. 

61 



In 1947, when the public health nurses became civil servants they became part 
of the Provincial Civil Service with its particular policies and regulations. These 
did not always fit the situation of a public health nurse in the field. The Director 
of Public Health Nursing made representation to the Civil Service Commission 
on behalf of the public health nurses, particularly regarding matters such as 
salaries, holidays, sick leave, etc. However, by 1950 the Civil Service Commis- 
sion agreed that duly elected representatives of the majority of field public health 
nurses could make representation in person and present "briefs" to them con- 
cerning matters within their jurisdiction. Accordingly at the 1951 Annual Public 
Health Nursing Council meeting, the first Personnel Practices Committee was 
elected consisting of Miss Mary Dunn (Manson), chairman, Miss Fern Primeau 
and Miss Dorothy Priestly. A detailed brief was presented to the Chairman of 
the Civil Service Commission to make him aware of the responsibilities of the 
public health nurses and the need for higher pay. The continuing work of this 
committee is shown later under "Negotiations and Bargaining." 

In the fifties the public health nurses were trying to increase their knowledge, 
and learn new skills but there was very little available in the way of short courses 
or workshops offered by the University. The College system and "Continuing 
Education" had not come into being in this province, so that the Public Health 
Nursing Council decided to set up an "Education Committee" to assist the 
members. The committee compiled literature on available programs, and in 
1963-64 set up a correspondence~course in conjunction with the Institute pro- 
gram on "the Scientific Method in Public Health Nursing," with 131 public 
health nurses participating (almost half). This was followed by other courses on 
research, and "The Canadian Society". The Committees activities filled a great 
need at the time. 

The work of the Public Health Nursing Council met its objective of "promot- 
ing the professional development and welfare of the public health nurse" before 
being discontinued in 1974 when the British Columbia Government Nurses 
Union was formed. Much credit must go to the executive and committees, as 
well as the presidents who guided its development. The presidents were: 



1943-45 Miss Alice Beattie 1958-59 Mrs. Phyllis Piddington 

1945-46 Miss Ann Murray (Quayle) 1959-60 Miss Lavinia Crane 

1946-47 Miss Eva Moody 1960-61 Mrs. Anna Mason (Larson) 

1947-49 Miss Dorothy Priestly 1961-63 Mrs. Florence Graham (Barbaree) 

1949-50 Miss Aileen Bond 1963-64 Miss Kirsten Weber 

1950-52 Miss Nan Kennedy 1964-66 Mrs. Frances Berry (Hobson) 

1952-54 Mrs. Pat Kahr 1966-68 Mrs. Edith Fisher 

1954-55 Mrs. Doreen Park (Gifford) 1968-70 Mrs. Diane Ouston 

1955-56 Miss May Macartney 1970-72 Mrs. Sheri Wood 

1956-58 Miss Joan Sutcliffe 1972-74 Mrs. Susan Frizzell 



62 




Ann Murray (Quayle), Venereal Disease 
Epidemiology Worker — Nanaimo 1945 

Public Health Nurses as Venereal Disease Epidemiology Workers 

By 1945, Dr. Donald H. Williams, Director of the Division of Venereal 
Disease Control located in Vancouver, realized that although the war was over 
venereal diseases were still in epidemic proportions and likely to spread rapidly 
throughout the province. Better follow up and treatment was needed outside 
Vancouver. Local clinics were established for treatment in high incidence areas, 
but the main effort was to be directed toward the prevention of new cases and the 
treatment of known contacts. Accordingly, an experienced and capable public 
health nurse, Miss Alice Beattie, was appointed to head up the field operation 
from the Vancouver headquarters. At the same time three public health nurses 
were made responsible for certain regions of the province. Miss Janet Kennedy 
(Egger) covered the Okanagan and Kootenays; Miss Ann Murray (Quayle), 
Vancouver Island; and Mrs. Nan Sewell, the Fraser Valley, The Vancouver area 
was serviced by the clinic until 1947 when Miss Queenie Donaldson, public 
health nurse, was appointed for the Vancouver Metropolitan Health Service. 
The public health nursing epidemiology workers visited the health units and 
nursing districts, reviewed the local venereal disease situation and assisted the 
public health nurses to incorporate epidemiological methods into the follow up. 
The program was successful and continued into the 1950's when health units 
finally accepted full responsibility for venereal disease control. 

Changes in the Public Health Nursing Division 

In July, 1944, Miss Heather Kilpatrick resigned for an appointment to a war 
relief agency — United Nations Relief and Rehabilitation Administration 
(U.N.R.R.A.). She had accomplished a great deal in a short time and had "set 
the stage" for a new director. She made a good start in organizing the public 
health nurses into a unified provincial group. Communications with individual 
public health nurses had improved through field visits, the Public Health Nurses' 
News and Views, Study Groups, the Institute, and the Public Health Nursing 

63 



Council. Many of her objectives had been accomplished and a general plan for 
the future was established. 

In September, 1944, Miss Helen Carpenter, Public Health Nursing Consul- 
tant, returned to Eastern Canada, and two provincial public health nurses who 
had been enrolled in post graduate studies in health administration at Public 
Health Schools in the United States under the sponsorship of the Provincial 
Board of Health returned to fill the two Public Health Nursing Consultant 
positions. They were: Mrs. Isabel Foster (Louks) R.N., B.A.Sc. (U.B.C.), 
M.P.H. (Johns Hopkins), Miss Monica Frith (Green) R.N., B.A., B.A.Sc. 
(U.B.C.), M.P.H. (University of Michigan) 

The Second Director of Public Health Nursing 

Miss Dorothy Tate (Slaughter) succeeded Miss Kilpatrick as Director of 
Public Health Nursing in September, 1 944. She had been a public health nursing 
consultant for a year and was well prepared for the appointment. In addition to 
her experience in public health nursing and tuberculosis, her academic qualifica- 
tions included a B.A.Sc. from the University of British Columbia, and the M. A. 
degree in Administration in Public Health from Columbia University. Miss Tate 
carried on the general policies of her predecessor. In the 1 945 Annual Report she 
lists the following expectations: ( 1 ) a uniform salary schedule to be instituted for 
all provincial public health nurses. At this time, on appointment, a basic salary 
was suggested to the local employing board, which was usually acted upon. 
However, some districts paid more, while some gave annual increases and others 




Dorothy Tate (Slaughter), Second Director of Public Health Nursing — 1944 



64 



did not. The proposed schedule was to start at SI 380 per year or SI 15.00 per 
month, and rise by $60.00 per year for four years when the salary would be S 1 620 
per year. A further increment would take place at ten and twenty years. This new 
schedule was an increase from the basic salary of SI 12.50 per month 
which had been in effect for several years. It should be noted that this schedule 
was somewhat similar to the teachers' schedule. The above plan did not in fact 
come into effect as the "reorganization" discussed later provided a different 
schedule. (2) a standard uniform had been selected by a nursing committee and a 
grant of $20.00 was to be available to help purchase the uniform. (3) policy 
manuals of approved written procedures would be started. (4) records to be 
simplified and (5) as too few public health nurses had agreed to join a proposed 
medical insurance plan, it could not be implemented. 

Needless to say it was some time before all the objectives were reached. 
However, the tuberculosis manual which appeared immediately was the first 
major manual, and at the same time an "information kit" on venereal diseases 
provided the public health nurses with an up-to-date guide on that subject. Miss 
Dorothy Tate became Mrs Warren Slaughter and left in June, 1948 for Saudi 
Arabia. Mrs. Slaughter had recognized the special problems of the public health 
nurses and had tried to meet their requests. She was to return later to the staff of 
Boundary Health Unit and to be appointed in 1955 as Public Health Nursing 
Consultant working out of a new office which was to be established in 
Vancouver. 




Ethel Fairbanks, P.H.N. Neighborhood clinic in a home — Duncan 



65 



Public Health Nurses do Immunizations 

During the early forties, renewed emphasis was placed on the need to protect 
the public from contagious or communicable diseases, especially when there 
were known preventive agents available such as vaccination for smallpox, 
biologicals for diphtheria, typhoid, tetanus, whooping cough and scarlet fever. 
Communicable diseases had not yet been controlled as indicated in the 1942 
annual report which stated that there were 60 cases of diphtheria, 1,750 cases of 
whooping cough, and 39 cases of typhoid fever (the population was under one 
million). The best way to accomplish control was to attain and maintain a high 
level of immunity in the community. A major target group was in the schools. 

As physicians and part time health officers left for the war, the remaining 
physicians had little time for preventive service and they were glad to pass 
immunizations on to the public health nurses who then assumed responsibility 
for planning and organizing clinics as well as giving the injections (five for scarlet 
fever!). Policy guides were set up by the Provincial Board of Health. Picture the 
scene — different from today. 

The public health nurse has arrived at a rural school with all her equipment 
transported in her car over a dusty unpaved road. The consent cards have been 
collected and the children and teachers are ready. The equipment consists of an 
electric hot plate if there is electricity or a coleman gas stove, preferably with two 
burners plus two pots so that needles can be boiled on one and syringes on the 
other. She has swabs, skin disinfectant, plus individual records for each child. 
She sets up wherever there is a convenient space which may be in the back of the 
classroom or a hall, or sometimes the teachers' lunch room, if there is one. She 
boils her equipment fop 20 minutes in water which she may have had to bring 
with her. She then proceeds with the injections, filling one syringe for a number 
of injections, using a fresh sterile needle for each child. Later, special "Control 
Syringes" were introduced which are supposed to prevent back leakage and five 
injections are given per 5 cc syringe. Care must be taken to see that the correct 
child receives the correct dosage and that it is recorded. Once back in her office 
she is responsible for cleaning and repacking equipment. It was many years 
before health offices received small portable sterilizers and some twenty years 
later before sterile disposable equipment was made available. 

However, the main point is that the public health nurses in the provincial 
service were the first in Canada to actually do immunizations rather than just 
organize and prepare for them to be done by a physician. The public health 
nurses were well trained in preventive medicine, familiar with the materials used, 
and were able to use their judgement in assessing the amount, time, and spacing 
for biologicals. Very few problems arose out of the millions of biologicals 
administered over the years. One of the great advantages was to make it possible 
for small numbers of immunizations to be given in sparsely settled areas where it 
was uneconomical for a physician to visit for this purpose. As a result, the public 
health nurses were able to achieve a high level of community protection from 



66 






most communicable diseases. In the health units organized at this time, the 
medical directors continued to do immunizations, but gradually as their areas 
extended, and their work loads increased, they too were glad to pass this task on 
to the public health nurses. It should be noted that smallpox vaccinations by 
public health nurses were not permitted until the late forties. Undoubtedly the 
change in policy contributed to the world-wide fight against smallpox and the 
eventual eradication of the disease. 




Doris Carter, P.H.N.. counsels mother in office of Health Centre — Nanaimo 1948 



World War II is Over 

With the war over in 1945, the province was ready for change. Public health 
nursing districts had been established throughout the province so that ninety 
percent of the population was receiving service. However, there still remained 
many rural areas with small populations outside the established nursing 
districts. 

The need for expanded public health service had become evident, and yet by 
1 945, there were only six health units outside the metropolitan area of Greater 
Vancouver, i.e. Saanich, South Okanagan, North Okanagan, Skeena, Central 
Vancouver Island and the Peace River. Public health nurses continued to point 
out the need for full time medical health officers, sanitary inspectors and clerical 



67 



assistants. Another step in the reorganization of public health nursing service 
was to take place before the goal of full time health units throughout the 
province could be accomplished. A continuing shortage of qualified public 
health nurses existed, and at the same time the demand for service was great in 
newly-settled and growth areas. The population was increasing quickly and 
spreading into the north and the interior. 

The Department of Health and Welfare Formed — 1946 

In 1946 "the Department of Health and Welfare Act" was passed, replacing 
the Provincial Board of Health with the Department of Health and Welfare. Dr. 
G.F. Amyot became the first Deputy Minister of Health. The Honorable George 
Pearson was the first Minister, and so health was now officially represented in 
the Cabinet. 

At this time Dr. J.S. Cull continued as Director of the Division of Local 
Health Services, and direct advisor to the Director of Public Health Nursing. In 
1 948 he was succeeded by Dr. J. A. Taylor, who had been a health unit director of 
the Fraser Valley, Peace River, North Okanagan and Central Vancouver Island 
Health Units. He was to hold this position for thirteen years and become Deputy 
Minister from 1962-1972. Because of his extensive field experience and personal 
qualifications, he was to be a great support to the Division of Public Health 
Nursing in the coming years. By 1946 the Deputy Minister of Health had 
delegated the major responsibility for the smooth running of the public health 
nursing service to the Director of Public Health Nursing through the Director of 
the Division of Local Health Services. However, he still depended upon the 
Director of Public Health Nursing to advise him concerning general nursing 
developments and changes and to represent the province in various provincial 
health and nursing committees. 

The Reorganization of the Public Health Nursing Service 

In 1946, organizational changes in the Department of Education provided an 
excellent opportunity for the Department of Health and Welfare to reorganize 
the public health nursing service and to equalize local costs. At the same time 
certain benefits could be made available to the public health nurses which would 
attract staff to fill the many vacancies existing and anticipated in the future. Dr. 
M.A. Cameron had recommended to the Department of Education that the 649 
school districts be absorbed into 74 proposed school districts. Action was to be 
taken on this recommendation. In many instances the proposed new school 
districts contained the same schools as the public health nursing districts which 
had been established to provide service over natural geographical areas. Some 
city school districts were extended into the surrounding rural communities 
which were not receiving public health nursing service. The Health Department 
decided that the time was opportune to reorganize the public health nursing 
districts to coincide with the new school districts. 



68 



A study had shown that the local cost of public health nursing service varied 
widely, from about eleven cents per capita in Saanich to sixty cents per capita in 
the Skeena area. The higher cost was due mainly to higher transportation costs 
brought on by greater distances between settlements and homes, poor roads, 
higher gasoline costs, more overnight accommodation costs, etc. In addition 
there was a lower population to support the cost. It was agreed that the local cost 
should be the same throughout the province and that the rate would be set at 
thirty cents per capita. At that time the total cost of the service was $1.00 per 
capita. The cost was compared to the price of a package of cigarettes (25 cents). 
Dr. Amyot expected Federal Health grants to compensate the Provincial 
government for one third of the cost, so that the total cost would be split evenly 
three ways, (ie) Federal, Provincial and Local. 

Under this new plan most local communities would benefit from a reduced 
cost, and the proposed benefits could lead to a stable staff situation. It was 
proposed that the public health nurses become civil servants with a similar salary 
scale throughout the province (except for the bonuses which all government 
employees received in the northern interior). They would receive other benefits 
not available under the existing set up such as a pension plan, workmen's 
compensation coverage, sick leave, and most important, the ability to transfer 
from one district to another without loss of accumulated benefits. 

It was necessary for each school board in the provincial area to agree to the 
proposed change. The Director of Public Health Nursing, Miss Dorothy Tate, 
and the Public Health Nursing Consultant, Miss Monica Frith, travelled the 
province to discuss the changes and obtain agreements from the sch6ol boards 
before the changes could be implemented. During 1946-47 the change gradually 
took place. Every school board was approached and subsequently agreed to the 
new organizational structure. 

The local areas agreed to provide office space for the public health nurse and 
the Department of Health and Welfare agreed to provide transportation, salary, 
and operating expenses. The total cost of the service was accepted by the 
Department and the local cost of 30 cents per capita was billed back to the school 
boards. It should be noted that at this time many schools and communities were 
located in "unorganized" territory and that the only taxing authority that 
covered organized municipalities, cities, villages and unorganized territory was 
the local school board. The local school boards then collected the tax and 
continued in an advisory capacity in the administration of the service. In some 
locations the public health nursing advisory committees continued with their 
function. However as time went on, without the stimulation of an annual fund 
raising drive, many of the advisory committees became less active in community 
public health issues. In the meantime health unit administration was increasing 
and union boards of health were becoming viable. 

The reorganization saw the closing of one of the chapters of public health 
history as the Cowichan Health Centre was refinanced and absorbed into the 



69 



Central Vancouver Island Health Unit. Mrs. Margaret Moss had been instru- 
mental in establishing the centre in 1 920, and in keeping the committee active for 
a quarter of a century. The old building which had been office and residence was 
ultimately abandoned. The office moved into a modern new health centre which 
was named "The Margaret Moss Health Centre" to perpetuate her memory. 

The Public Health Institute 

"Continuing Education" had been recognized as a staff need, and in 1941 the 
Public Health Nurses' Refresher Course was replaced by the "Institute" which 
was set up for public health nurses, medical health officers and sanitarians. 
During the first years the three day meeting was held during the Easter school 
holidays at the Empress Hotel in Victoria. The philosophy was that all staff 
should participate jointly in educational programs concerning new develop- 
ments in public health in order to develop a team approach to public health 
problems. The program was planned by Dr. Amyot, Dr. Cull, and Miss Kilpa- 
trick, and presented at joint sessions, with time being allocated for separate 
meetings for the various disciplines. This approach worked well when the staff 
was small, and public health fairly new. Apart from the educational value and 
the objectives of improved teamwork and morale, the meetings contributed to a 
feeling that the staff belonged to an important organization. The public health 
nurses realized that they were not working alone, and that there were similar if 
not worse health problems in other districts. The cost of the Institute was shared 
with the participants paying for their accommodation and meals while the 
Provincial Board of Health paid for transportation and a banquet. The banquet 
was the highlight of the social program, which featured baked Alaska, held on 
high and lighted, as the waiters paraded into the ballroom at the Empress. For 
the first fifteen years the staff from designated health units presented "skits" 
generally satirizing their district work — some in operetta form. These were 
great fun both in preparation and presentation. It would be best not to comment 
too much on the "after the banquet" get togethers which, too, became a 
tradition. 

As Dr. Amyot was highly regarded in the United States by public health 
leaders, he was able to attract outstanding public health figures to the Institutes 
as key speakers. 

One of the highlights of the forties was the combined meetings of the Cana- 
dian Public Health Association and the Western Branch of the American Public 
Health Association in Vancouver in 1948. Apart from the advantage which the 
staff had in meeting with public health workers from the entire North West, it 
provided Dr. Amyot with the opportunity to show off "his public health nurses" 
of whom he was justly proud. At this time British Columbia had the best overall 
coverage of public health nurses in the North West (94% of population). Mrs. 
Slaughter (Tate) and Dr. Amyot arranged a great pageant when all the public 
health nurses marched on to a stage in their new uniforms — winter, summer, 



70 




Skit by Central Vancouver Island Health Unit at Institute banquet in the fifties. Florence Graham 
(Barbaree), I'.H.N., performing 



and northern — to stand beneath the new British Columbia Public Health 
Service Crest. The script which was read to honor the public health nurses 
follows: 

The March of Public Health in British Columbia 

They march through rain and blizzard! 

They journey over mountain and river! 

They press on to the end of the road — those intrepid individuals — who 
give personality and meaning to that intangible wealth of a nation — 
PUBLIC HEALTH. 

Go north to the Peace! — Go East to the Kootenays — travel the length 
and breadth of riotous British Columbia, and you'll encounter the colorful 
threads of a web of wisdom — each strand an individual whose aspirations 
are driving will, and striving, to the high purpose of bringing wealth to a 
nation — the Public Health Nurse — serving British Columbia. 

The march is not the sound of tramp, tramp, tramping feet — nor is it the 
throbbing roar of planes in the sky. It is the march of Spring — the beauty 
of gentleness — the lovely tide of Nature's unhurried march of light and 
life! 

The wealth of British Columbia — the Public Health Nursing service. 

Who whips into action when unknown illness strikes a school child and 
takes one life, two lives, six young British Columbian lives. Who directs 



71 




British Columbia Public Health Service Crest — 1948 



72 



sanitation engineering for canneries, camps, boom towns and ghost towns 
where faulty disposal may endanger innocent British Columbian lives. 

The Public Health Nurse is the tactile probe of a tremendous purpose 
— clothed in the workaday title of the British Columbia Department of 
Health. She is the link between those credulous individuals who comprise 
the public, and the specialists who arm the department with knowledge 
and skill. 

You'll meet our Public Health Nurse in places where strong men do not 
expect to see women — as on a precipitous road in the Public Health 
District of Nelson — in Winter. There's sleet in the air. On the road, it has 
turned to glare ice. 

Why is our Public Health Nurse on this slippery mountain road? 

She is going to visit the district. 

Why should anybody visit a district country school on a winter day? 

Last Fall the Doukhoubors burned down the school. Sessions are being 
held in a tent — heated by an oil stove — lighted by hanging lamps. Thirty 
children — crowded in the tent — sometimes too cold — sometimes too 
hot — can develop an amazing amount of trouble in an amazingly short 
time — trouble that causes many a heartache — many a night of watching a 
child in fever. 

Goodol' Public Health Nurse. Nobody knows WH Y she does it but she 
DOES it — over crooked mountain roads — by boat where there is no road 
— by dogteam across white snowfields — and by courage when the only 
road is through the heart of that resistant individual who — multiplied 
many times — makes the slow-moving public. 

The first Public Health Nurse appointed in British Columbia to the 
generalized service was in Saanich. Nineteen nineteen was the year — and 
the month — April. Spring was moving in the heart of the Legislators. 

Within four years — four more nurses were added to the staff — year by 
year, the staff has proved itself as the working front that bears the brunt of 
contact with that persistant individual who argues that health is just a 
gamble — you have it, or you don't. 

Today, there are 240 Public Health Nurses in service throughout the 
cities and rural areas of British Columbia — serving with the British 
Columbia Public Health service — in the greater Vancouver and Victoria 
area — with the Victorian Order of Nurses — and with industrial and 
commercial industries. 

Today — 94% of the population of British Columbia receives Public 
Health Nursing service. The first University in the British Empire to offer a 
course in public health nursing leading to a University degree was the 
University of British Columbia. 

These facts throw the bright light of accomplishment and high purpose 
on British Columbia's achievements in Public Health. 



73 







Public Health Nurses' Pageant at the joint meeting of the Canadian Public Health Association and the Western Branch of the American Public Health 
Association — 1948 



From the landing of Captain Cook at Nootka in 1778 up to the present 
hour — far-sighted health officials have taken a prominent part in the 
development of that priceless asset — Canadian Health — through the 
development of our own British Columbia Health Service. 

We pay tribute today to the women who continue to play dominant roles 
in the development of British Columbia's Health Service. 

The Public Health Nurse — the Mobile flexible force of the Public 
Health service — the spectacular? — Yes! — In the Cariboo we see a Public- 
Health Nurse travelling on horseback — by canoe — stopping only to rest 
in a deserted hunting cabin — pushing on to the logging camp, where a 
woman — seriously ill, awaits. 

In the Peace River — in Winter — we see the Public Health Nurse 
clothed in colorful regalia, — parka — ski suit — sealskin boots — 
travelling by air — by horse and sleigh — through blinding snow storms 
— to Moberly Lake, where the Indians hopelessly caught by a diphtheria 
outbreak await her help. 

The commonplace? — Yes. Watch the Public Health Nurse — in her 
smart blue uniform — moving quietly — deftly through the community 
— in Summer — in Winter — in Fall and Spring. She is the point of contact 
for maternal health — child hygiene — adult hygiene — for control of 
communicable diseases — for sanitation — and for health education. 

Behind the Public Health Nurse stretches an intricate organization 
bearing the wisdom of centuries — the skill of science — and the enlight- 
ened purpose of men and women whose enterprise and devotion are 
building a nation already wielding power and opinion in the councils of the 
world. 

Behind her stands a triumph of democratic organization — the local 
Health Unit — the local advisory Public Health Committee — the local 
Health Officer and the profound resources of the administrative headquar- 
ters in Victoria and Vancouver. 

The Public Health Nurse has won the right to wear British Columbia's 
coat of arms. She wears it lightly, debonairly, as the gold and silver spur 
that mingles the depth of British Columbia's glorious motto — with the 
breadth of the Public Health Nurse's day-by-day endeavour. 

"Splendor sine occasu" — Magnificence without intention. The artless 
beauty of nature — the ramparts of the snowclad Rockies — the Majesty 
of the Cascades — the endless forests of green — the blue of mountain 
lakes — where no man's foot has ever trod. These are the symbols of the 
unseen service of the Public Health Nurse — the quiet word of confidence 
spoken to a lonely woman — frightened by the approach of physical events 
beyond her ken — the happy words spoken to a mother watching over her 
child — the healing word of inspiration — spoken to a broken soul. 

Joined with this noble crest is another symbol — the ancient sign of 



75 



service — the winged staff of Mercury — instant and without delay. 

High symbolism, to match noble intention — a badge for the brave — to 
be worn with pride through danger and beyond — breathing into it the 
shining light of magnificence without intention — "splendor sine occasu". 
This — the insignia of the British Columbia Public Health Service. 

SA L UTE the advance guard — who carry health to our province — who 
symbolize the Canada of tradition — in the Pacific North West — the 
Public Health Nurse serving British Columbia. 

The Public Health Nurses' Uniform Insignia 

The British Columbia Public Health Nursing Service Crest was designed by 
Inspector Karl Ledeaux, an eminent member of the British Columbia Provincial 
Police which no longer exists. The "Crest" consists of a crown to represent the 
Monarchy, followed by the flag of British Columbia, and the caduceus which 
consists of two snakes representing healing, coiled around a winged wand or 
staff. The latter represents an ancient herald's wand as carried by the messenger 
god Hermes or Mercury. This symbol is frequently used to represent medicine or 
health. In this crest it represented the educational or teaching aspects of health 
care. Balancing the symbols was the inscription "B.C. PUBLIC HEALTH 
SERVICE." 

Although the crest was initially designed for the public health nurses' uniform 
it gradually became the official "logo" and was used on all literature and 
correspondence from the Health Department for about thirty years. The health 
unit director and public health inspectors for many years wore small silver 
insignia lapel pins as part of their official identification. The crest has many 
pleasant memories. It was first introduced in the 1948 pageant at the Western 
Branch meeting of the American Public Health Association and the Canadian 
Public Health Association. It was also part of the silver spoons awarded to 
public health nurses on retirement with long service records. 

Public Health Nurses' Uniforms of the Forties 

In the early forties Miss H. Kilpatrick tried to introduce a standard uniform but 
because of the war was unsuccessful in securing suitable material. At this time the 
public health nurses wore a kind of uniform which was a blue shirtwaist-style 
dress, similar to earlier styles with stiff white celluloid collars and cuffs. Each 
nurse chose her own style and material. 

By 1944, on the recommendation of a committee of nurses, a standard 
uniform was introduced. It was a tailored, made-to-measure bright navy blue 
suit, with a white shirtwaist blouse worn with collar and lapels over the jacket. 
The colored embroidered crest introduced in 1948 was worn on the left sleeve of 
the jacket, which closed with three brass insignia buttons. The style and some- 
what formal aspect of the uniform was much in vogue after the war. This suit 
continued for many years, and was adapted to style changes, as skirts and jackets 



76 



lengthened and shortened according to the current fashion. 

A navy blue gabardine greatcoat was worn in cold weather (with zip-in lining), 
and in extremely cold weather as in the North, public health nurses wore ski 
pants and parkas as indicated. 

In summer the uniform was a robin's egg blue sharkskin American Golfer 
dress. This was a smart shirt waist style, and washable. A silver brooch with crest 
was worn at the neck. All crests and pins were on loan from the Department. 

The public health nurses were generally happy with their smart distinctive 
appearance. They were easily recognized and their uniform proved to be an 
advantage in providing an easy entry into homes, when travelling alone, when 
the car broke down, or if someone had a message for the public health nurse. 
Children always recognized the public health nurse and waved to her as she went 
by! The R.C.M.P. could be aware of her travels and be ready to assist in an 
emergency. 

The First Organized Home Care Program — 1947 

The organized "Home Care" program was not entirely new to the province 
when it was introduced in 1947, as bedside nursing inthe home had been part of 
the public health nurses' work since they were first employed in Saanich and 
Cowichan. However, as time went on, more hospital beds became available and 
the demand decreased. This was evident when the Metropolitan Life Insurance 
Company discontinued home nursing coverage as part of their policy in the early 
40's. 

As the work of the public health nurses changed and new programs were 
developed, home nursing care was given only on a short term or demonstration 
basis. The public health nurse would visit a home and teach someone in the home 
how to give the needed care. She would return as often as needed to supervise the 
care given and to help the family. Acutely ill patients were sent to hospital. 

In 1947, the South Okanagan Health Unit planned to introduce home nursing 
in an organized or continuous manner as part of their service, and at the same 
time get a homemaker service started. It was found that one of the most urgent 
needs for many persons ill at home, was for homemaker or housekeeping service. 
There was need for someone to do simple home routines, get meals, and perhaps 
provide personal care similar to that which a relative would give a sick person. 
Some professional nursing care was needed especially for chronically ill persons. 

The Kelowna area agreed to set up a homemaker service and the Health 
Department agreed to provide nursing service. Additional part time nurses 
would be employed for holidays and the weekends. During the week the public 
health nurses would provide the care and their districts would be reduced if they 
had a heavy load of home nursing. Public health nurses would continue the 
policy of teaching the patient to be as self-reliant as possible with the expectation 
that care could eventually be discontinued. As this project was experimental, no 
charge was made locally for the home nursing service. 



77 



Prior to setting up the service, consideration had been given to the possibility 
of bringing in another agency such as the Victorian Order of Nurses for this 
service. However it was agreed that it would be preferable to have the existing 
health service set up the program thus avoiding duplication of administration 
and keeping costs at a minimum. 

Miss Alice Beattie, Nursing Supervisor of the Division of Venereal Disease 
Control was seconded for three months to get the program started. It was proved 
that it was possible for a health unit to add a home care program with additional 
staff. With the homemaker service established at the same time under the city of 
Kelowna Welfare Department this program provided the basis for further 
developments at a later date in the home care service. 

The Third Director of Public Health Nursing 

Following her marriage Mrs. Dorothy Slaughter (Tate) left in June, 1948, to 
be succeeded by Miss Monica Frith (Green) who had been Public Health 
Nursing Consultant for almost four years. Miss Margaret Campbell (Jackson) 
who had joined the Division in 1948 was appointed to the consultant position. 
She had been a staff nurse at Abbotsford and Kamloops and senior nurse in the 
Kamloops-Lillooet-Ashcroft area. She joined the Division as a Supervisor, and 
on her return from the University of Michigan where she completed the M.P.H. 
degree she was appointed Assistant Director. 





Monica Frith (Green), third Director of Public Margaret Campbell (Jackson), Assistant Direc- 
Health Nursing on a visit to Vanderhoof — 1948 tor of Public Health Nursing — 1948 



78 



The Great Flood of 1948 

In the spring of 1948, the snow on the mountains with rivers flowing into the 
Pacific Ocean was greater than usual, and had an abnormally high water 
content. During the early part of May, while British Columbia hosted the joint 
annual meetings of the Canadian Public Health Association and the Western 
Branch of the American Public Health Association in Vancouver, the weather 
was glorious, sunny and warm. As the public health staff returned home the 
unseasonably hot weather continued, while the level of the rivers rose, and the 
Fraser River quickly reached flood level. Before dykes could be strengthened, 
water seeped through the banks spilling into the Fraser Valley as it had never 
done before, inundating farmlands, homes, villages and towns. Land communi- 
cation to the interior was cut when roads were covered with water in the worst 
flood in recorded history. 

At that time there were no health units in the Fraser Valley, although the 
region was completely staffed with public health nurses who served their dis- 
tricts. The government declared an emergency, and appointed Dr. George F. 
Elliot, Provincial Health Officer to represent the Health Department on the B.C. 
Flood Control Committee, and to organize additional health services as indi- 
cated. Miss Margaret Campbell from the Public Health Nursing Division was 
assigned to Abbotsford, where the main activities of the Committee were located 
and was made responsible for co-ordinating the public health nursing services in 
the Fraser Valley. 

The public health nurses automatically set about helping flood victims as their 
areas became involved by providing information about such matters as food and 
water safety, sanitation, first aid, etc. Some nurses had to use boats to check the 
condition and administer health care or advice to people who refused to leave 
their homes. Miss Betty Pickard (Bradley), a public health nurse, was a key 
figure in helping the people in the Agassiz district. It had been decided that 
typhoid fever was a threat, and that typhoid immunizations should be com- 
menced. Accordingly, clinics were set up quickly to protect the residents and 
workers on the dykes. Over 35,000 persons were completely protected by three 
individual injections, while many thousands more received a booster dose, or an 
incomplete series. Besides organizing and manning the clinics, public health 
nurses supervised the evacuation centres set up in the wartime Air Force base at 
Abbotsford. 

The use of the public health nursing staff during this emergency demonstrated 
the advantage of the "reorganized" system whereby all public health nurses were 
centrally employed and it was possible to deploy staff as needed. Public health 
nurses from districts not involved, such as Gibson's, volunteered to supplement 
the staff in the Valley. 

Although most of the flood damage was in the Fraser Valley, places such as 
Trail on the Columbia River also had extensive flooding, while other centres had 
only minor problems. 



79 



Once again the public health nurses were commended for their dedication, 
hard work, and long hours (no overtime compensation). No flood borne disease 
occurred. This was due largely to the services of the public health nurses, the 
sanitary inspectors, and to the general public health measures instituted as well 
as the co-operation of the public. 

What the Generalized Public Health Nurse Did in the Forties 

The Director of Public Health Nursing, Miss Monica Frith, outlined in her 
1948 report the activities of the average public health nurse as follows: 

— Serves a population of around 5,000 people. Usually lives in the largest 
community and travels 20-50 miles to serve the adjacent rural area. 

— Supervises the health of around 1 ,000 school children usually at 2 large and 8 
one or two-room schools. During routine school visits she organizes and 
assists with school medical examinations. She inspects children not seen by 
the doctor, and visits the children's homes to explain physical or behavioral 
difficulties to parents. She advises on the lunch program, helps the teacher 
with classroom instruction on health matters, provides the latest information 
and watches over the environment and sanitation of the school. She watches 
for communicable or skin diseases. She keeps immunizations up to date, and 
routinely does vision and hearing screening. 

— Supervises about 20 persons with tuberculosis, their families and contacts. 

— Organizes and conducts about 5 child health conferences (formerly Baby 




Margaret Latimer, P.H.N., inspects school children at Cowichan Lake School in the 40 s 



80 



Clinics) with an average attendance of 1 5-20 infants and preschool children 
per month. 

- Makes numerous home visits for infant supervision particularly in areas 
where scattered populations make clinics or child health conferences 
impractical. 

- Organizes and conducts immunization clinics available to all. 

— Conducts health teaching both for groups and individuals on general health 
practices stressing diet, personal care, home sanitation, etc. 

- Home nursing on short term basis, plus demonstrations of procedures to 
teach family members home care. 

— Provides general health service to persons living on certain Indian Reserves. 

— Selected public health nurses provide field experience of two weeks or a 
month for nurses from the University of British Columbia Nursing program. 

— Selected public health nurses provide short field experience in public health 
nursing for undergraduate students from hospital schools of nursing, (i.e.) 
Royal Inland, Kamloops; St. Eugene, Cranbrook; Royal Columbian, New 
Westminster; St. Joseph's, Victoria. 

— Other special activities (i.e. flood, mobile clinics, etc.) as indicated. 

In 1948, 94% of the people in the province had public health nursing service 
available to them. 

Public Health Nursing Service on Selected Indian Reserves 

Public health nurses serving with the Department of National Health and 




Gladys Skinner (Piket) P.H.N. , Fort St. John, visits Halfway Reserve — 1942 



81 



Welfare were located in various parts of the province to provide public health 
nursing service to Indians living on Indian reserves. However, some small 
reserves were in or adjacent to districts served by provincial public health nurses. 
As it seemed very inefficient for the Indian Health Services' public health nurses 
to travel long distances for a few people when there was a provincial public 
health nurse nearby, arrangements were made for the provincial nurses to 
provide service in this situation for certain reserves. The Health Department 
received payment at the rate of $1.25 per year, for each registered Indian 
belonging to the reserve. In the late thirties this plan was in effect on Vancouver 
Island at Nanaimo and Alberni Canal, in the Okanagan at Penticton, Oliver, 
and Keremeos, in the East Kootenays at Cranbrook, Creston and Tobacco 
Plains, and at Lillooet in the Fraser Canyon. As time went on and more 
provincial public nurses were added, more reserves were taken over. The plan 
worked well, as public health nurses carried out a preventive health service on 
the reserves through special clinics and home visits. The public health nurses 
from the Provincial and Federal agencies exchanged pertinent information and 
often completed projects together. 

Tuberculosis Field Nursing 

Tuberculosis continued as a major health problem in the forties and remained 
the fourth leading cause of death until 1948. In 1942 there were 527 deaths, in 
1946 there were 575. Tuberculosis hospitalization, treatment and prevention 
costs utilized the major portion of the health budget. However, determined 
efforts were being made to control this disease. By 1948 mobile X-ray vans were 
added, to travel throughout the province in an attempt to X-ray everyone. The 
Christmas Seal orgahfzation partly sponsored this service and assisted with the 
organization. As could be expected the success of the venture depended upon the 
local public health nurses and the health units. Everything else stopped when the 
mobile X-ray van arrived and everyone worked full out to get everyone X-rayed. 
This effort to find tuberculosis cases, and then treat them with new drugs finally 
paid off, as the tuberculosis death rate began to drop by the end of the forties. 

First Time Study and Case Load Analysis — 1948 

The first time study and case load analysis was carried out by the public health 
nurses in 1948 as set up by Miss Lyle Creelman. She had just returned from 
U.N.R.R.A. (United Nations Relief and Rehabilitation Association) where she 
had been administrator of nursing activities for the British zone in Germany. She 
was the former Director of Public Health Nursing for the Vancouver Metropoli- 
tan Health Committee and had some time available while waiting for her 
appointment as the Director of Nursing for the World Health Organization. 
(She too was a graduate of the B.A.Sc. program from the University of British 
Columbia and also held a Master's degree from Columbia University). She 
agreed in the interval to look into the administration of the provincial public 



82 



health nursing service. To do this she had each nurse complete a case load 
analysis and a detailed time study. These studies provided valuable objective 
data on which service needs could be assessed along with other pertinent 
information. As a result of this first study, Miss Creelman concluded that the 
public health nurses were spending too much time on non-professional clerical 
work and recommended that clerical time be made available to them. In subse- 
quent years, similar studies with appropriate modifications were used to mea- 
sure particular programs. 

Federal Health Grants Assist the Development of the Public 
Health Nursing Service 

1 948 marked the year that the Federal Government through the Department 
of Health and Welfare recognized the need to improve health services in the 
provinces and made funds available for this purpose. British Columbia was 
given a two and a half million dollar grant to be used to set up new health 
services, to expand existing services and to train health professionals. Specific 
grants were available for certain services such as general public health, hospital 
construction, mental health, tuberculosis, professional training, research etc. A 
complicated formula for each grant was established. It is noteworthy that 35 
cents per capita was available in the general public health grant rising to 50 cents 
per capita in eight years. Projects for the use of the funds had to be approved 
provincially and federally before any money could be spent. 

In the first year of the grants, nine new public health nursing positions were 
added, an internship plan was established to qualify nurses for public health 
nursing and an educational program was set up for supervisory public health 
nurses. New equipment was made available for the use of the public health 
nurses such as movie projectors, slide machines, audiometers, new films and 
reference texts for local public health libraries. Over the years the grants made 
new information and technology available to be used for community health 
education. 

Some Factors Creating Nursing Changes in the Late Forties 

In 1948, the Hospital Insurance Act was passed which made hospital care 
available to all residents of the province. A small co-insurance of one dollar a 
day was charged while in hospital and the monthly premium which was set 
initially was removed by 1952. The provision of hospital care for everyone 
changed the structure of care in the province. No longer were patients either 
"pay" or "non-pay". The non-pay patients had for many years received care from 
appointed physicians and interns. Now everyone would be admitted as a "first 
class patient." 

Also new antibiotics came on the market as the "sulpha" drugs were intro- 
duced to combat infection. Acute infections became controllable for the first 
time. Scarlet fever immunizations were discontinued in favor of drug therapy. 



83 



Many new drugs would follow so that patient care changed drastically. New 
drugs effectively treated gonorrhoea and syphilis and reduced the infectious 
period. 

Also early ambulation got under way. Up to this time a simple appendectomy 
kept a patient in hospital 14 days and in bed until just before discharge. The same 
was true for a maternity patient. 

These changes altered the picture of both hospital care and treatment of 
patients at home. 

The Need for More Local Public Health Nursing Supervision 

The need for more local or close at hand supervisory assistance and guidance 
for public health nurses emerged in the mid-forties. In the early years each public 
health nurse had been responsible for the program in her own district. She 
usually worked alone except in a few larger centres such as Saanich and Cowi- 
chan where several nurses were located. However, as the population of the 
province grew, so did the number of public health nurses and more two or three 
nurse districts were established. In multiple nurse districts, one of the public 
health nurses, usually the most experienced nurse or the nurse who had been 
there longest was considered the senior and saw that the office ran smoothly. 
However, she did not officially direct or oversee the work of the other public 
health nurses, and the individual programs could vary. The transient popula- 
tion, characteristic of British Columbia, began to expect a uniformity of service 
as they moved around the province, and complained when they did not find the 
same public health nursing service in another community, e.g. "Why were there 
no prenatal classes?" Also as new districts were formed, health unit directors 
wanted to establish more uniformity of program within their units. It was 
generally believed that this could be accomplished best by having a supervisory 
nurse who could visit the branch or district offices and help the public health 
nurses adjust their programs, when necessary, to fit into established health unit 
policies. 

The Division of Public Health Nursing believed that a basic minimum gener- 
alized service should be available to all persons within the province, and that this 
could best be accomplished by providing leadership and supervisory assistance. 

The first start had been made in 1 942 when Miss Heather Kilpatrick and Miss 
FyvieYoung(U.B.C. Instructor in Public Health Nursing and Dr. H.E. Young's 
daughter) arranged for Miss Kathleen Leahy from the University of Washington 
in Seattle to give a five day course for potential supervisors at the University of 
British Columbia. It was recognized that a different educational background 
was necessary for this type of position. 

The Plan for Local Supervision and First Appointments 

By 1 948 a plan was devised to provide more local supervision for public health 
nurses. The need was accentuated by the ever increasing local demand for more 



84 



public health nurses, and the lack of qualified and experienced nurses to meet the 
requests. With the war over, road building began again and more people moved 
to the province and especially to the north and central interior. The need for 
more public health nurses was easy to forecast! 

The idea of more supervisory help was welcomed by some public health 
nurses, especially the recent graduates who made up over half of the provincial 
staff. However there remained a large group who had enjoyed the freedom to 
plan their work and conduct it according to their judgement and who did not like 
the idea. It was agreed by the Division of Public Health Nursing that supervision 
would be introduced on a local level in such a way that the standard of service 
would remain high and that every effort would be made to allow the public 
health nurses the opportunity to use their initiative as they had done in the past. 
This would be brought about by developing supervisory nurses who showed 
talent for this type of work and in addition had assistance through special 
education. 




Dorothy Priestly. P.H.N. Supervisor. Central Vancouver Island Health Unit on retirement — 1965 

The first public health nursing supervisor to be appointed locally was Miss 
Dorothy Priestly in 1 947. She was a former hospital supervisor who had opened 
the Prince Rupert Nursing District in 1937, and served in the Chilliwack and 



85 



Duncan nursing districts. She was appointed to the Central Vancouver Island 
Health Unit which had expanded to include the Cowichan Health Centre area 
with a total complement of eleven public health nurses located in six centres. 
Miss Priestly continued as supervisor in the Health Unit until her retirement in 
February, 1 965. She was noted as a competent supervisor and gracious lady. Her 
influence was such that many of her young public health nurses eventually went 
on to senior and supervisory positions. She also made an outstanding contribu- 
tion in helping to design health centres which would make the work of the public 
health nurses efficient and convenient for the public. 

Later in 1947 Mrs. Pauline Yaholnitsky was appointed Regional Supervisor 
of the three northern units — Peace River, Cariboo and Skeena. She too was an 
experienced public nurse, who had opened the Rolla district in the Peace River 
in 1935 and Quesnel, in the Cariboo, in 1940. In 1944 she was the first public 
health nurse to be appointed Acting Director of the Peace River Unit, a position 




Pauline Yaholnitsky, P.H.N. Supervisor of the Northern Interior Region. Anne Wiens, P.H.N. 
— Quesnel, 1956 



86 



which she held for three years. In addition to the public health nursing course, 
Mrs. Yaholnitsky had completed a special program in Public Health Nursing 
Administration at McGill University. She became a well known, popular and 
historic figure in the north as she made her rounds assisting the public health 
nurses with their work. She was known not only for her able organizational 
ability but also as an expert sportswoman. She always created quite a stir when 
she appeared at the Institute with her fashionable and elegant hats. Mrs. Yahol- 
nitsky, or "Yoho" as she was known, served as Regional Supervisor until she 
retired in 1957. 

Two more regional supervisors were appointed pending a time when full time 
supervisors would be required in each district. Miss Mary Dunn, a well qualified 
public health nurse who had completed a Master's program in administration 
from Columbia University was appointed in September 1948, to theSaanichand 
South Vancouver Island Health Unit and in addition covered the Gibson's and 
Howe Sound Nursing Districts. Eventually her services were limited to the 
Health Unit when the number of nursing staff increased. Miss Dunn remained 
until 1959 when she left for Rhodesia to become Mrs. John Manson. In 1951 
Miss Margaret Cammaert was appointed as regional supervisor for the Koote- 
nays. These appointments marked the beginning of the new local supervisory 
program for the public health nursing service. 

The Criteria for Supervisory Positions 

General criteria were established in the late forties to help determine the 
number of supervisory positions required. The plan recommended at that time 
by the National Organization of Public Health Nursing of the United States was 
adopted for use. It stated that one full time supervisor was required for eight to 
ten public health nurses. Where there were fewer, a senior nurse was appointed 
who also carried a smaller district than a staff public health nurse. The size of her 
district depended upon the number of nurses being supervised. This system was 
suitable for the provincial service where there were many small centres some 
distance from each other. The above criteria worked well for many years. 

Professional Training Plan for Supervisory Nurses 

The new Federal Health grants were designed to assist in professional training 
in order to up grade general health services. Projects for long and short term 
training were approved in 1 948, and it was therefore possible to begin a plan for 
the orderly introduction of public health nursing supervision to the service and 
to provide candidates with the educational background needed to carry out their 
special responsibilities. 

The short term project began with a short course for nineteen potential and 
supervisor nurses in 1948 in Victoria, in an old unused building near the Parlia- 
ment Buildings. Miss Marion Murphy, Professor from the University of Michi- 
gan, and a former Supervisor and Consultant Public Health Nurse gave a two 



S7 




P.H.N.'s attending the first Supervisory Course for Public Health Nurses in Victoria — 1948 

week condensed version of the university course in supervision and returned for a 
two week follow up the next year. The public health nurses attending began to 
understand their changed role and as a result set about their new tasks with more 
enthusiasm and understanding. It should be noted that at that time there was no 
one in Canada with comparable background to conduct the course. The Univer- 
sity of British Columbia was still concentrating on the basic program. This first 
supervisors' course provided a good introduction to administration and supervi- 
sion for those who were proceeding for additional education. It also had the 
advantage of the group getting to know one another. The following public health 
nurses attended Miss Marion Murphy's course in 1948: 

Miss Joan Appleton, Summerland; Miss Doris Carter, Vernon; Miss Mar- 
garet Campbell, Victoria; Miss Margaret Cammaert, Trail; Miss Mary Dunn, 
Saanich; Miss Betty Elliot, Coquitlam; Miss Monica Frith, Victoria; Miss Freda 
Hilton, Cranbrook; Miss Nan Kennedy, Chilliwack; Miss Eva Moody, Courte- 
nay; Miss Janet Pallister, Surrey; Miss Dorothy Priestly, Nanaimo; Miss 
Dorothy Paulin, Victoria; Miss Fern Primeau, Vancouver; Miss Marjorie Stani- 
forth, Dawson Creek; Mrs. Madeline Werts, Kelowna; Miss Barbara Smith, 
Delta; Mrs. Pauline Yaholnitsky, Quesnel. 

The long-term project consisted of two bursaries per year for two suitable 
supervisory nurses to complete an academic year of post graduate training in 
administration and supervision as related to public health nursing. The candi- 
date was to be a member of the field staff showing potential for this type of work. 



88 



The candidate remained on full salary, received tuition fees, a small book 
allowance, and the necessary travel expenses. A return in service of three times 
the length of the course was required. 

At this time diploma programs were available in administration for public 
health nurses at McGill University and the University of Toronto. Public health 
nurses with a baccalaureate degree generally preferred to enroll in a Master's 
Public Health Course available to them only in Public Health Schools in the 
United States. 

The first senior nurses to accept bursaries to include administration and 
supervision were Miss Barbara Smith who enrolled in the University of Toronto 
program, and Miss Margaret Campbell who attended the University of Michi- 
gan. Miss Smith was to remain on staff for 32 more years as she retired in 1 980 
with 37 years of experience. Miss Campbell remained until 1954. 

Over the years the two annual bursaries were to provide opportunities for 
further education for all supervisory public health nurses as the number of 
bursaries kept pace with the appointment of supervisory and consultant public 
health nurses. 

Continuing Shortage of Public Health Nurses Spawns 
the Internship Training Plan 

After the war, in 1946, a large number of nursing sisters qualified as public 
health nurses using their discharge credits, and filled many of the existing 
vacancies. Thereafter, a shortage continued of public health nurses to meet the 
demand. The reorganization of the public health nursing service in 1947 created 
a need for many new positions. A number of districts were enlarged, as in Nelson 
where there had been one public health nurse and another was now required as a 
large rural area had been added to the district. 

In 1948, the public health nursing trainee or internship plan was set up to meet 
the need for more qualified public health nurses. It called for the temporary 
employment of suitable registered nurses to work in the public health field for a 
short time. They were placed in carefully selected districts under the close 
supervision of a qualified public health nurse, who first arranged a planned 
orientation course which permitted the nurse to assume limited responsibilities 
for a small public health nursing district. The registered nurse must have 
indicated that she intended to enroll in a recognized course in public health 
nursing after a limited period of experience. If the nurse was not suitable for 
public health nursing she resigned. Federal Health Grants were made available 
to the trainees while attending University amounting to $100.00 per month 
stipend, a $25.00 book allowance plus tuition fees. In exchange the nurse agreed 
to work for a period of two years after completing the course. Ten bursaries per 
year were made available for ten years, then increased to 15 for another decade. 
The plan continued for over twenty years with minor adjustments in the benefits, 
.and over 225 registered nurses qualified for public health nursing. The few 



89 



trainees who failed to fully complete their work commitment repaid their 
financial obligations. During the latter part of the sixties fewer nurses took 
advantage of the bursaries although many benefited from the field experience. 
The program proved to be worthwhile both to the nurses and the Department. 
One of the many advantages to the service was the establishment of a pool of 
public health nurses with good field experience being available to open up new 
districts after they completed their university program. Without this group of 
qualified public health nurses the service would not have been able to expand 
and maintain a good level of service throughout the province. Many of the 
nurses initially received a diploma or certificate in public health nursing were 
able to utilize their university credits when they returned at a later date to 
complete a degree program in nursing. 

The Hamilton Report — 1949 

Public health nursing in the 40's closed with a favorable report made by Miss 
Lucile Petry, Assistant Surgeon General, United States Public Health Service, 
in 1949 as part of her contribution to the James A. Hamilton and Associates 
Report on Hospital Services in British Columbia. In her report Miss Petry 
states: "The Health Branch of the Department of Health and Welfare has an 
exceedingly well conceived plan for public health nursing services in the pro- 
vince, and has succeeded in implementing the plan extensively. The combination 
of local and provincial financing and design of program bring sound planning 
and operation. The fact that the Provincial Health Service is often first on the 
scene and aims at a comprehensive service should avoid the complications found 
elsewhere, where two or more services with slightly different functions must later 
go through the difficult stages of co-ordination and final integration. . . . the 
desirable trend towards generalization of public health nursing service is well 
advanced here. . . . the nurses are generally well prepared and receive expert and 
dynamic leadership. A stimulating permissive atmosphere pervades the service, 
and co-operative planning is evident both among nurses themselves and between 
nursing service and administration." 

The forties created many changes which built a firm foundation for growth, 
and the future seemed bright as the worth of preventive services had been 
recognized. 



90 




Public Health Nurses group picture at the time of the Public Health Institute. Parliament Building steps — 1949 



V. THE FANTASTIC FIFTIES AND THEIR 
INFLUENCE ON PUBLIC HEALTH NURSING 



93 



The Fantastic Fifties And 
Their Influence On Public Health Nursing 

The decade of the fifties was another period of change as the economy 
gradually picked up due to new construction, road building, industrial and other 
developments which had lagged behind during the war. The interior of the 
province opened up with easier access from the coast due to new roads, airlines, 
ferries, and the reactivated Pacific Great Eastern Railway (now British Colum- 
bia Railway) to the interior. Prosperity once more seemed on its way. 

The population gradually increased both from immigration and a new high 
birthrate much above the depression level of 13/ 14 to 25/26 per 100,000. The 
greatest percentage increase was in the Peace River, Northern Interior, Cariboo 
and Okanagan. Another trend was apparent as the over 60 age group was 
increasing twice as fast as in the rest of Canada. The affluent society had arrived. 
It was a good time generally, as production stepped up, prices remained rela- 
tively stable, jobs were plentiful, and the unemployed were relatively well cared 
for by the government. 

There were fewer young people coming into the labor force because of the low 
birth rate during the depression. As a result. there was a continuous shortage of 
nurses and especially of public health nurses. Those who graduated had their 
choice of positions both in and outside the province. The Public Health Nursing 
Division was able to fill positions only because of the public health nursing 
trainee program and because it was possible to recruit 50 percent of the new staff 
from outside the province. The British Columbia Public Health Service was 
becoming known as a good agency. In spite of the drawbacks, the number of 
public health nurses in the province just about doubled over the decade as new 
districts were set up and existing services expanded to meet the population 
increase which was about 25 percent. 

By 1 959 there were 449 public health nurses employed in public health nursing 
in British Columbia as follows: 

191 — Provincial Service 

152 — Metropolitan Health Committee of Greater Vancouver 
8 — New Westminster City (part of Simon Fraser Health Unit) 
15 — Victoria City, Esquimalt, Oak Bay Health Departments 
24 — Indian Health Service - Federal Government 
59 — Victorian Order Of Nurses 

How Programs Changed 

During this period there were scientiic and medical discoveries which altered 
the public health nursing service to fit with the changing concepts of the 
treatment and prevention of disease and the promotion of positive health. Some 
of these developments included Salk vaccine for the prevention of poliomyelitis, 
streptomycin for the treatment of tuberculosis, B.C.G. vaccination for tubercu- 



94 




P.H.N, confers with truck driver en route to Kaslo in Selkirk Health Unit — 50 s. "Travel in the 
Kilties" 




P.H.N.'s car en route to the Lardeau country — 50 s 



95 




Shirley Gow ( Labrousseure), I'. H.N., ready to fly from Port Alberni to Bamfield - 1 952 "Travel in 
the 1- it ties 




Jean Fleming, P.H.N. , travelling with Social Worker and driver to Halfway Indian Reserve off 
Alaska Highway — 1959 



96 




Jean Fleming, P.H.N., Dawson Creek, travels by dog team to Halfway Indian Reserve — 1959 

losis, measles vaccine, the reintroduction of home nursing, housekeeping or 
homemaker services, prenatal and parentcraft classes, expanded resources for 
the treatment of handicapped children and adults, more emphasis on rehabilita- 
tion, and more mental health resources. Better tools became available for 
screening such as the portable "otochek" for hearing screening and illuminated 
boxes for vision testing. More films, slides etc. for health teaching were pro- 
vided. These developments required public health nurses to have a broader 
preparation and to adjust their programs to adapt to new developments. 

A two pronged approach was made to deal with the new developments. The 
first was to provide more in-service education for existing staff and the second 
was to encourage the enrichment of the content of university preparation for 
public health nurses. 

An annual in-service education program was set up for short courses on 
pertinent topics. The first was a two-week mental health course in 1 953 given by 
Miss Ruth Gilbert at the University of Washington. It was followed by a 
two-week prenatal care course at Nanaimo's new health centre, given by Miss 
Aileen Hoganfrom Maternity Centre, New York, a five-day Pediatric Course in 
Vancouver given by local pediatricians and a one-week course in interviewing 
techniques given by Dr. James Tyhurst at the Mental Health Centre at Burnaby 
in 1 959. These programs were attended by public health nurses from all parts of 
the province and included nurses from other agencies. Also much new material 



97 




"PRENATAL" Institute held in Nanaimo Health Centre. Alice Beattie, Dorothy Slaughter (Tat 
Monica Frith (Green), Barbara Smith — 1957 

was presented each year at the annual Institute meetings when all the publ 
health nursing staff were present. 

Nursing students from hospital schools of nursing and the University learne 
more about the practice of public health nursing as more opportunities for fiel 
placements became available in new districts throughout the province. 

Public health nurses continued to be well prepared, adaptable and able t 
adjust to needed change. However, everything was not perfect as was brougl 
out in the Canadian Public Health Association Report of 1950. Much moi 
needed to be done! 

The Baillie — Creelman Report — 1950 

The "Baillie — Creelman" report presented in June, 1950 by the "Stud 
Committee on Public Health Practice in Canada" provided guidelines whic 
were to have a positive effect on the provision of public health nursing and publ 
health in British Columbia in the future. Miss Lyle Creelman, former Director < 
Public Health Nursing for the Metropolitan Health Committee, Vancouve 
referred to earlier, and Dr. J.H. Baillie of the Canadian Public Health Associ; 
tion visited the provinces and conducted a Canada wide study on the practices < 
the nurse and physician in official agencies to determine what bearing the: 
practices might have on the recruitment and maintenance of public health stal 



98 



Their most relevant recommendations included: 

(1) More qualified public health nurses to be prepared by universities. 

(2) More public health nurses to become qualified for supervisory positions. 

(3) Lay workers to be used for non professional activities. 

(4) Clerical assistance to be made available to public health nurses. 

(5) Volunteers to be used to expand programs. 

(6) As part of better supervision, the importance of staff education was 
stressed. Also the need for staff evaluations and policy manuals. 

(7) Suggestions on programs were made such as: 

— a reduction in the amount time spent in the school program. 

— more time for prenatals. 

— the public health nurse should be used more as a mental health worker. 

(8) Demonstration and research of completely generalized public health nurs- 
ing services including bedside nursing should be done. 

(9) Personnel Policies — improved salaries to encourage recruitment. 

(10) Public health nurses to do immunizations legally. 

(1 1) Health Centres to be used to provide full public health services. 

The above recommendations today seem quite logical but at the time caused a 
good deal of controversy. Also some would cost money, which might not be 
welcomed by the politicians who would have to find the funds. 

Poliomyelitis Becomes the Major Communicable Disease Concern 

Communicable diseases were gradually decreasing as a major health concern, 
brought about by intensive immunization and improved sanitation. By the end 
of the fifties no diphtheria cases had been reported in three years and it seemed 
that this disease was being eradicated. Tuberculosis was on the wane due to 
improved treatment which had moved largely to the community level. At this 
time public health nurses were giving about 1,000 injections of streptomycin to 
patients each month. In 1958, the tuberculosis sanitorium (350 beds) at Tran- 
quille closed. Venereal disease was still a problem and public health nursing 
epidemiology workers were located in the health units in the high incidence areas 
of Dawson Creek, Prince George and Prince Rupert for follow up and treatment 
of cases and contacts. 

However the number of poliomyelitis cases continued to increase. In 1954 
there were 787 cases with 26 deaths. Epidemics broke out in the late summer and 
local communities would get into a panic state. Public health nurses were 
involved in epidemiology but there was no known preventive measure until Salk 
vaccine was introduced in 1955. The first year 49,000 children were immunized 
in the province. Because of the great fear everyone wanted protection and the 
next year 100,000 persons were immunized (3 doses each) at mass clinics held 
throughout the province at which the public health nurses administered the 
vaccine in syringes and needles made available through the Kinsmen's clubs. It 
was estimated that by the end of the fifties one quarter of a million, or almost all 



99 




School immunization clinic. Marysville, East Kootenay — 1955 






Children wait their turn for immunization at Marysville School, East Kootenays - 1955 



100 



persons under the age of nineteen had been protected by Salk vaccine. The 
vaccine subsequently became available at all child health clinics on a routine 
basis. 

The Atomic Age Brings Civil Defence Nursing 

The atomic bombs dropped over Hiroshima and Nagasaki helped finish the 
war with Japan in 1945. This new weapon with its potential for killing and 
maiming the civil population struck terror in the minds of people who felt 
helpless to cope with this unknown weapon. By 1950, information had been 
collected on the effects of the bomb, the treatment of victims and how best to 
minimize the effect. The federal and provincial governments set up a series of 
courses to educate key persons on how to deal with the possibility of atomic 
attack. The federal government established a Civil Defence Department with the 
ultimate purpose of encouraging local planning to take care of a possible attack. 
Included was the training of necessary personnel and the stocking of medical 
supplies in emergency hospitals, first aid depots, emergency kitchens, and giving 
instructions to the population on how to protect oneself. 

The Public Health Nursing Division took an active part in the preparation 
and organization of an educational program dealing with the nursing aspects of 
Civil Defence and ABC (Atomic, Bacterial, Chemical) Warfare. In 1951, Miss 
Margaret Campbell, Assistant Director, and Miss Fern Trout, Instructor, Re- 
gistered Nurses Association of British Columbia, initiated a two hour orienta- 
tion session on this subject which they presented to hospital and public health 
nurses in the smaller centres throughout the province. That same year a four day 
course was presented in Vancouver by a team of experts from the staff of the 
Federal Department of Health and Welfare to 75 nurses, representing all regions 
6f the province many of them public health nursing supervisors. The partici- 
pants returned to their districts and conducted condensed versions of the course 
to local groups of nurses. Gradually throughout the fifties and sixties nursing 
instructors received basic training in ABC Warfare, and the subject was gradu- 
ally integrated into the basic nursing curriculum. With their new knowledge 
public health nurses were able to be active participants in the drawing up of local 
disaster plans. Fortunately there have been no atomic attacks, and the material 
has been adapted for use in other civil disasters such as floods, fires, air crashes, 
etc. 

Awards for Distinguished Service — (Diphtheria Epidemic) 

Newspaper headlines were made in January, 1950 when it was discovered that 
two public health nurses had heroically helped control a diphtheria epidemic in a 
remote northern community. Miss Aileen Bond, Senior Public Health Nurse 
from the Peace River Health Unit, and Miss Amy Wilson, Public Health Nurse, 
Indian Affairs, Whitehorse, were the heroines. Miss Wilson answered a call for 
help in -50° F weather from a remote Indian village known as Halfway Valley off 



101 



o 




Aileen Bond, Snr. P.H.N., Dawson Creek and Indian boy, Halfway Valley Reserve — Dee. 



1949 




Amy Wilson, P.H.N., Indian Affairs, Whitehorse, with team of horses as she leaves for Halfway 
Valley Indian Reserve — Dec. 1949 




Travel to diphtheria epidemic at Halfway Valley Indian Reserve. Amy Wilson, P.H.N.; Aileen Bond 
P.H.N. - Dec. 1949 



103 



the Alaska Highway, to find the Indians starving, and a diphtheria epidemic in 
progress. She telegraphed for help and on Christmas Eve Miss Bond volunteered 
to leave Dawson Creek to assist and bring in needed medical supplies. She made 
the trip by small plane, horse and sleigh and snow shoes under treacherous 
travelling conditions and in extremely cold weather. Miss Bond's official report 
stated — "The Indian camp where the diphtheria raged was discovered by 
spotting a funeral fire on a nearby hill showing that there had been another death 
that day (3 deaths at that time). When approached at night the forlorn camp 
looked most eerie, for it consisted of a collection of canvas teepees and a few 
squalid unchinked rough shelters. The only sound of life was the multitude of 
miserable hounds, and smoke curling from the tops of the tents. The primitive- 
ness of this camp was beyond description — the houses had no floors — no 
windows — no furnishings other than cotton blankets on the ground, and one 
stove with a black pot in which all food was cooked and eaten. 

On first inspection three acutely ill patients were found. Two had complete 
membranes covering their throats, and the third had had his membrane removed 
by another Indian who had reached in with pliers and extracted the complete 
membrane. This patient's life was saved by the operation. There were five deaths 
in all and only four of the 52 inhabitants escaped the disease." The public health 
nurses strapped the antitoxin and penicillin to their bodies to keep them from 




Aileen Bond, Snr. P.H.N. — Dawson Creek Amy Wilson, P.H.N. — Whitehorse 



104 



c 




Aileen Bond, Snr. P.H.N., Peace River Health Unit, receives Distinguished Service Award from the Honorable Gordon Wismer. Seated 
Appleton (Norris), Elvira Patterson, Grace White, Jean Taylor — April 1 950 



s Joan 




gtibun £imh, JR^, 

puMit ^ealiff ^Curse 



^foarfr fnr ^tsimgutslfefr jlerfrte 



In recognition- of outstanding courage and devotion to duty 
in combating and promoting control of an epidemic of diphtheria 
in Halfway Valley, Peace River District, British Columbia, in 
December, 1949, and January, 1950. 

JL his epidemic, originating among the Indians in Stoney 
Creek Reservation, required the provision of control measures in most 
primitive surroundings and during extreme winter weather. 

JL his action, involving personal sacrifice and personal risk 
above and beyond the normal call of duty, is an excellent example of 
co-operation between the Federal and Provincial health services in joint 
action for the protection of the public health. It adds a magnificent 
chapter to the developing history of public health nursing in Canada. 

April 1950 

106 



freezing! For ten days, broth or hot brandy and sugar were the only nourishment 
for the indians. Food was eventually dropped by R.C.A.F. planes. As the 
epidemic subsided the public health nurses commenced immunizing all persons 
within travelling distance of the highway and in ten days had inoculated 947 
individuals. 

The work of the public health nurses received much publicity at this time. The 
government felt that they deserved special recognition, and struck a new medal 
"The Distinguished Service Medal" for heroism above and beyond the call of 
duty. The specially created medal was centred with a small diamond added by 
the Health and Welfare Minister, the Honorable George S. Pearson to show his 
personal appreciation of their heroic action. The medals were presented April 
15th at the annual Public Health Institute at the Empress Hotel in Victoria by 
the Acting Premier, the Honorable Gordon Wismer. 

Organized Home Nursing Programs Extend 

At this time, the advantages of hospital-based home care was being advocated 
due to the success of the Montifiore plan in New York. As the Vernon hospital 
had a bed shortage, a study project was introduced by the North Okanagan 
Health Unit in 1951, in cooperation with the Vernon Jubilee Hospital to deter- 
mine whether a similar home care project could be successful in a small commun- 
ity. It was planned to use the services of private physicians, public health nurses 
from the Health Unit, local social workers, and to set up a new homemaker 
service. The study was conducted for six years, and demonstrated that hospital 
beds were saved and adequate service provided to patients. Patient stays in 
hospital were shortened, resulting in better acute care bed utilization. The 
service was expanded later to accept all patients needing care, not limited to 
hospital discharges. 

Utilizing the experience of the two successful projects (Kelowna and Vernon), 
the Health Department established a pattern of home nursing care which could 
be part of health unit service. Saanich and South Vancouver Island Health Unit 
led the way, setting up in 1954, the first organized home nursing service funded 
by a local assessment. An additional charge often cents per capita was levied 
locally (in addition to the existing thirty cents). No charge was made to the 
patients. Emphasis was placed on teaching the patient or the family to eventually 
take over the care of the patient whenever possible, under the public health 
nurse's supervision. Weekend nurses were employed, and as the service grew the 
first part time registered nurse was employed on a half time basis to do routine 
home nursing. She was Mrs. Elizabeth Fosker who worked for twenty years in 
this capacity. 

In the early years of the program it was necessary to educate not only the 
public health nurses but doctors and other professional workers on the value of 
home care. Rehabilitation nursing was an essential part of the service, which 
involved getting the patient to do as much as possible for himself (or herself). 



107 



o 

oo 




1953 ANNUAL INSTITUTE FOR PROVINCIAL PUBLIC HEALTH WORKERS 

Photo on Court House steps, Vancouver B.C., April 8, 1953 
1st row — Miss Barbara Vidal, Miss Marion Williams, Mrs. Phyllis Swaisland, Miss Dorothy Kergin, Miss Maxine Bolton, Miss Doris Carter, Miss Doris 
Widdifield, Mrs. Anna Grant, Miss Helene Boehme, Miss Frances Neighbor, Miss Bernadine Conroy, Miss Margaret Latimer, Miss Marguerite Cusson, 
Miss Frances Hewgill, Miss Catherine McKinnon, Miss Greta Ward, Miss Christine Boland 

2nd row — Miss Barbara Smith, Miss Gladys Skinner, Miss Leola Carr, Miss Alice Beattie, Miss Nan Kennedy, Miss Kerstin Nelson, Mrs. Margaret 
Strongitharm, Mrs. Pauline Yaholnitsky, Miss Oonagh Donald, Miss Paula Schwoerer, Miss Lucille Giovando, Mrs. Eva Walker, Miss Shirley Gow, 
Miss Dorothy Neuman, Miss Alison Neilans 

3rd row — Miss Olive Clancy, Mrs. Phyllis Payton, Miss Margaret Cammaert, Mrs. Edith Fisher, Mrs. Jean McAllister, Miss Ada O'Brien, Miss 
Elizabeth Tisdale, Miss Lorene Monohan, Miss M. Bannerman, Miss Ruth Stevens, Miss Doris Vosburg, Mrs. Kay Allan, Miss Fern Primeau, Miss Mary 
Dunn, Mrs. Margaret Johnson, Miss Margaret Campbell, Miss Hazel Whittington, Miss Dorothy Morris, Miss Lavinia Crane, Mrs. Muriel Dann, Mrs. 
Estelle Bates, Miss Pauline Siddons 

4th row — Mrs. Dorothy Slaughter, Miss Betsy Quayle, Miss Margaret Steeves, Miss Shirley Main, Mrs. F. Gladstone, Miss Joan Russell, Miss Doris 
Milligan, Mrs. Charlotte Brown, Miss Gertrude Rach, Mrs. Shirley MacFarlane, Miss Helen MacAleece, Miss Alice Damgaard, Miss Margaret Goble, 
Miss Joan Appleton, Mrs. Montie Croft, Miss Miriam Cressman, Mrs. D. Donaldson, Mrs. Phyllis Piddington 

5th row — Miss Muriel Treece, Mrs. Eileen Ramsay, Miss Frances Stewart, Miss Letty Watson, Miss Elizabeth Layton, Miss Marjorie Craik, Miss 
Barbara Bryson, Miss Doris Bews, Miss May Macartney, Miss Aldred Ker, Miss Dorothy Priestly, Miss Lorraine Carruthers, Mrs. Pat Kahr, Miss Hazel 
Fulmore, Miss Joan Morison, Miss Phyllis Dangerfield 

6th row — Mrs. Louise Hughes, Miss Mae Conn, Miss Isabel Andeson, Miss Doreen Gifford, Mrs. Jean Keays, Miss Joan Sutcliffe, Miss Monica Frith, 
Miss Marian Boyd, Miss Irene Stewart, Miss Helene Byrt, Miss Beverly McNair, Miss Mary McKinlay, Miss Marian Bellis, Mrs. Jessica Field, Miss Ann 
Purdie, Miss Nora Woods, Mrs. Margaret Calvert 



The new theory of early ambulation and activity had not been fully accepted by 
all. Sometimes the public health nurse who gave the care during the week would 
work hard to encourage the patient to get out of bed and do as much as possible, 
while the weekend old time nurse would kindly put the patient back to bed and 
do everything for him. However, in time these obstacles were overcome. 

Gradually new home nursing care districts were set up where the residents 
agreed to the additional levy often cents per capita, and nine districts (Kelowna, 
Vernon, Saanich, Courtenay, Campbell River, Powell River, Ladner, Keremeos 
and Qualicum) were established by the end of the decade. By 1959 complete 
statistical analyses were being made of the programs, including the diagnosis of 
the patient, type of care given, time involved in care, travel, etc. The costs could 
be easily worked out. The data from the annual statistical reports formed the 
basis for making changes in the program. 

These programs demonstrated that patients with mental or physical problems 
could be cared for adequately at home and that beds could be better utilized in 
general hospitals and other types of institutions if similar community programs 
could be established. 

New Community Health Centres 

One of the great features of the fifties was the building of community health 
centres when a total of sixty were constructed. The funds came from Federal 
Health Grants when equally matched by provincial and local money. At long 
last, public health nurses had suitable working quarters of which they could be 
proud. The health centres were all sizes, designed for nurses in single and 
multiple nurse branch offices and larger health unit headquarters. It was a joy to 
have adequate space for child health conferences where counselling could be 
private and space for mothers' classes including room for exercise classes. There 
were offices for visiting clinics, workrooms for autoclaves, cupboards for medi- 
cal supplies, pamphlets, projectors, libraries, etc. Some had auditoriums for 
community health education and other meetings, while others made space 
available to local health related agencies. A local club such as the Kinsmen's or 
Rotary usually sponsored the building. Often the district donated the land and 
some labor, while grants were available from the B.C. Tuberculosis Society, the 
B.C. Cancer Society, the Red Cross, and other agencies. The health centres were 
at last visible and attractive and helped raise the morale of the staff and the 
prestige of the service in the community. Some districts honored pioneers by 
naming the centres for them such as, The Eileen Ramsay Health Centre at 
Quesnel to honor this public health nurse who served there from 1946 to 1960. 
The Margaret Moss Health Centre at Duncan honored the longtime president of 
the first health centre at Duncan. Where health centres were not built improved 
accommodation was arranged in provincial buildings and rented quarters using 
similar designs. 



109 




Similkameen Health Centre. Keremeos "Open- 
ing Day" — 1955 



New Oliver Health Centre — 1957 




ErV-**- ./"S^ ; 



»* V.,..^,.. „-,.... , 



New Community Health Centre, South Okana- 
gan Health Unit — Kelowna 1953 




Rossland Health Centre for one nurse. Nancy 
Lee, P.H.N. Supervisor; Joan Sutherland, 
P.H.N. — 1957 



Negotiations and Bargaining 

During the fifties the process of bargaining was evolving in professional and 
other associations, and British Columbia was at that time, and continues to be 
the most "unionized" province in Canada. The climate in the Registered Nurses 
Association of British Columbia (RNABC) was changing as they began to 
improve benefits for their members. They had been certified in 1946 as a 
bargaining agent under the Labor Relations Act and had established provincial 
salary schedules. All provincial public health nurses were members of the 
RNABC. Also as civil servants they could belong to the B.C.. Government 
Employees' Association which was seeking bargaining rights. The BCGEA had 
been meeting with the provincial government representatives to discuss benefits 
for their members, and they would have been happy to include the public health 
nurses in their group. However, the Civil Service Commission advised the public 
health nurses through the Public Health Nursing Council that as they were a 
"group" they could represent themselves, or have another person or agency 



110 






represent them. For a number of years the public health nurses could not give 
majority approval for representation to either the RNABC or the BCGEA and 
settled on representation by the Personnel Practices Committee of the Public 
Health Nursing Council. 

The first brief was presented to the Civil Service Commission in 1952, by Miss 
Mary Dunn, Public Health Nursing Supervisor of the Saanich and South 
Vancouver Island Health Unit, and Chairman of the Personnel Practices Com- 
mittee. In this brief only salaries were considered and it was requested that the 
RNABC schedule be followed which would pay a public health nurse $245 per 
month. The salary in effect was $221 per month, less than paid elsewhere in the 
province to nurses with similar qualifications. Subsequently all members of the 
three member committee met with the Civil Service Commission, but it was not 
until 1959 that the public health nurses gained the salary level recommended by 
the RNABC. In 1966, Miss Evelyn Hood, the Labor Relations Director of the 
RNABC began to accompany the committee to the meetings with the Civil 
Service Commission. The Committee became more active as they began to 
investigate all aspects of personnel policies, working conditions etc, as the pace 
of labor activities quickened in nursing and elsewhere. It studied many proce- 
dures and methods currently in effect, and it is interesting to note that by 1974, 
they drew up an excellent paper on the feasibility of staff public health nurses 
evaluating their supervisors. 

By 1974, the last members of the Personnel Practices Committee participated 
in negotiations as the public health nurses' representatives, as civil servants had 
attained the right of collective bargaining. Two members, Miss Sandra McKen- 
zie, and Miss Vera Andrews represented the public health nurses in the Profes- 
sional Nurses group of the British Columbia Government Nurses' bargaining 
unit. 

Public Health Nursing Consultants' Program 

The public health nursing consultants continued to be generalized although 
each one had special responsibility for specific programs. Because of their 
special backgrounds they were able to help supervisory nurses with general 
management and career plans for staff nurses, as well as program development. 
They introduced many new ideas to help improve the local service. 

In 1951 the first regional consultant, Miss Margaret Cammaert was appointed 
to the East and West Kootenays based at Trail. She had been a staff nurse at 
Summerland and a senior nurse in the Trail-Nelson area following her gradua- 
tion with a B.S.N, from the University of Alberta. In 1950-51 she completed an 
M. P. H. degree at the School of Hygiene at Johns Hopkins University, where she 
had specialized in maternal and child health. Miss Cammaert's assignment 
included trying out new ideas in her specialty to determine whether they could be 
introduced into the provincial setting. As a result of local trials, new policies 
were established such as routine teacher-nurse conferences which replaced rou- 
tine annual school medical examinations, an appointment system for child 



11 




Ponticton Health Centre. Public Health Nurs- 
ing Supervisors Nancy Lee, Hazel Whittington. 
— 1957 





McBride's New Health Centre. Joan Sutcliffe, 
Supervisor P.H.N.; Winifred Bryant, P.H.N. 
- 1958 



1 






Summerland office of the South Okanagan 
Health Unit. Hattie Empey, P.H.N.; Madeleine 
Werts, Snr. P.H.N. 




Trail Health Centre. Headquarters of West 
Kootenay Health Unit — 1958 




Oflicial Opening Day, Qualicum Health Centre, 
Central Vancouver Island Health Unit — June 
1958 



New head office of East Kootenay Health Unit, 
Cranbrook. Frances Hewgill (Mitchell), Kay 
Marshall, Rena Rankin, Kay McKinnon, Char- 
lotte Brown, Monica Frith (Green) — 1958 



112 



health conferences and improved reference materials made available to all 
public health nurses. She revised the much used infant and preschool monthly 
letters which had been originally written by the federal government so that they 
could be sent out by the Provincial Health Department. By 1954 it was con- 
cluded that the work of public health nursing consultants would be most 
effective when centrally located and Miss Cammaert was transferred to a newly- 
established office in Vancouver on Laurel street in one of the old buildings 
originally used by the University of British Columbia. 

During this period Miss Margaret Campbell continued as Assistant Director 
with special responsibility for research studies and home care. 

A new consultant position was established in Victoria in 1951 with a mental 
health specialty. Miss Lucille Giovando was appointed upon her return from the 
University of Minnesota where she had specialized in mental health. She was an 
experienced public health nurse having served in Rural Kelowna in 1943 until 
she opened the Cumberland Public Health Nursing District in 1946, and had 
been a senior nurse at Nelson. In addition to her general responsibilities, her 
assignment was to promote mental health and increase referrals to mental health 
travelling clinics. 

By 1955, Miss Campbell, Miss Giovando, and Miss Cammaert had moved on 
to positions with the World Health Organization. The Division was fortunate to 
recruit suitable replacements. 

Mrs. Dorothy Slaughter (Tate), the former Director of Public Health Nurs- 
ing, who was employed as a staff nurse in Boundary Health Unit rejoined the 
Division in the Vancouver-based consultant position in 1955. 




Alice Beattie. Consultant P.H.N.; Geoffrey Page. Supervisor. Division of Vital Statistics — 1956 



113 



Miss Alice Beattie joined the Division in 1956 after completing advanced 
studies at the University of Washington. Her name has been mentioned pre- 
viously as supervisor of nursing in the Venereal Disease Division and in connec- 
tion with the establishment of the first home nursing service at Kelowna. Miss 
Beattie graduated from St. Joseph's Hospital in Victoria and completed the 
Public Health Nursing program at the University of British Columbia in 1938. 
Prior to opening the Courtenay Public Health Nursing Service in 1941 she was 
employed as a public health nurse in the Cowichan Health Centre in Duncan and 
later was supervisor in The West Kootenay, South Okanagan and Boundary 
Health Units. Her first assignment as Consultant along with Mr. Geoffrey Page 
from the Division of Vital Statistics was to investigate the need for clerical and 
other non-professional field staff, and to recommend standardized office proce- 
dures and administration. All main offices and branch offices were visited by this 
task force, and far reaching recommendations were made in the final report 
which became the "Administration Bible" for many years. Miss Beattie con- 
tinued to work on the policy manuals, advised on the school health program, 
and revamped the public health nurses' records committee so that it had broader 
representation and became the Public Health Records Committee. For a 
number of years she continued as consultant to the clerical staff in addition to 
her nursing responsibilities. This was not inconsistent as most of the records 
handled by the clerical staff were public health nursing records. Miss Beattie was 
able to see the health unit aide position established and to advise on this new role 
in the health units. 

Following Miss Beattie's appointment, the other public health nursing consul- 
tant position was not filled due to general cuts in the Civil Service. However the 
Director and two consultants continued to visit their ever expanding districts 
and to generally assist the supervisory nurses with their work. Fortunately Mrs. 
Pauline Yaholnitsky, Northern Supervisor, was able to provide public health 
nursing consultation to the northern health units. Emphasis was being placed on 
staff development to encourage talented public health nurses to obtain good 
varied experience in the field and to take advantage of educational opportunities 
to fit them for future responsibilities in leadership positions. This was always an 
"iffy" situation as romance, matrimony, and family responsibilities also played 
an important part in the decisions. However the overall objective of the con- 
tinued improvement of service was the guide. 

During the fifties the Director was able to hold regular senior nurse meetings 
at Institute time. The Director and consultants arranged an educational pro- 
gram and provided a forum for the supervising nurses to share their concerns 
and obtain assistance with their particular problems. 

Improvements in Working Conditions 

(The Five Day Week, Clerical and Aide Assistance, Orientation, etc.) 

In the overall, working conditions for public health nurses in the fifties had 



114 




Tnwar 



KJ* 



PSST:^ iii' ' ft 



Lunch time in the Cariboo Health Unit (old), Prince George 1952. Bruna Facchin, P.H.N.; Pauline 
Yaholnitsky, P.H.N. Supervisor; H.T. Lowe, M.H.O.; Elizabeth Layton, P.H.N.. 




' 



Laurel Benham, San. Inspector; Elizabeth Layton, P.H.N.; Miriam Cressman, P.H.N.; Sheena 
Smith, P.H.N. Cariboo Health Unit (Old) — Prince George 1952 



115 



improved. The five day week had come in allowing two day weekends. Public 
health nurses were no longer officially on call on the weekends as "weekend" 
nurses were employed in most districts. 

No longer did newly employed public health nurses start on their own and just 
do their best. Planned orientation to the program and the district was arranged. 
Staff education was being conducted on a local level and elsewhere. There were 
opportunities to qualify for educational leave and to obtain bursaries for 
advanced education related to the public health nurse's work. 

Although salaries were not high they were adequate. The public health nurses 
now contributed to the provincial government superannuation plan, and to the 
medical benefit plan available from the British Columbia Government 
Employees' Association. 

However too much time was still being spent on non-professional activities, as 
indicated by annual time studies. In 1 958, for example, 4% of their time was spent 
in activities which could be done by an aide while 4.8% of the time was being spent 
in non-professional clerical duties. The Survey Team (Beattie and Page) had 
recommended a ratio of one clerk to four public health nurses. In the past a 
clerk-secretary had always been available for the health unit director, and some 
clerical assistance had been available to the public health nurses depending upon 
the local situation. Now additional clerks were being added according to the 
recommended ratio, in both a full and part-time basis. The need for "lay" 
positions was pointed out again (as recommended in the Baillie-Creelman 
report). The Civil Service Commission was reluctant to employ another type of 
worker but agreed to try out two health unit aides who would assist the public 
health nurses in preparing the nursing and medical supplies, i.e. clean, sterilize or 
autoclave needles, syringes, catheters, etc., also clean the refrigerator, stock the 
biologicals, etc. As no classification was available in the Civil Service Manual 
they were employed as "bottle washers". In 1957, the first appointments were to 
Saanich and Boundary Health Units involving seven health centers. 

Much use was made of volunteer workers who continued to assist public 
health nurses at special clinics and child health conferences. Valuable time was 
contributed by the hundreds of volunteers who greatly augmented the public 
health nurse's time so that she could spend more time on professional activities. 

The fifties saw the completion of health unit coverage in the province as the 
Simon Fraser, West Kootenay, South Central, Boundary and Selkirk Health 
Units were established. The public health nurses now worked within the health 
unit structure rather than in independent nursing districts. 



116 




Coffee time, Port Alberni office, Central Vancouver Island Health Unit. B.C. Chapman, Clerk; Joan 
Grace, P.H.N. ; Lillian Cawthorne, P.H.N. ; Betty Pullen, P.H.N. (R) — 1959 




Freda Hilton, P.H.N. Supervisor. East Kootenay Health Unit — Cranbrook 1957 



117 




Public Health Nurses gather for a staff meeting at Duncan, Central Vancouver Island Health Unit. 
Gladys Skinner, Myrtle Saxton, Marian Mortimer, Florence Graham, Alice Heron (King) — 1955 



x 




Christine Grant, P.H.N., Lake Cowichan, prepares for a Child Health Conference — 1956 



118 




Maureen Parkinson (I'yne), I'.H. Nursing trainee counsels at a Child Health Conference — Saanich 
1959 



119 



VI. THE TURBULENT SIXTIES 



121 




am ;.«:£■■■ 

Margaret Baird (Wilson) P.H.N. Ready to go! — Saanich 1961 



122 






The Turbulent Sixties 

The sixties became another period of growth and change both in the province 
and in the public health nursing service. The population increased by 35% to 
over 2 million people. Immigration accounted for most of the increase, as the 
birthrate fell steadily from a high of 26.1 per 1,000 population in 1957 to 17.0 in 
1 969. The age distribution was presenting new problems as the post-war "baby 
boom" moved through the system. Forty percent of the population was under 
twenty years of age, creating a need for more services for children and young 
adults. At the same time the over sixty age group (13% in 1968) was increasing, 
creating a need for more services for the elderly. 

After the stability of the fifties, social unrest marked the sixties which were 
characterized by the rebellion of youth against tradition, the status quo, and 
authority. Existing ways were questioned and many young people developed an 
alternate lifestyle which was exemplified by the "hippy" movement which came 
from California. The new free lifestyle to some extent created new areas of health 
concern. It centred around communal living, vegetarian diets, sexual freedom 
and drug use, resulting in an increased venereal disease rate, increased illegiti- 
macy, malnutrition and family breakdowns. Changes in approach to these 
health problems became necessary. Such things as street clinics became a reality 
as public health nurses made every effort to meet and help young people in their 
own environment. Also, new plans were gradually developed to assist the aging 
population. 

The Number of Public Health Nurses Increases 

In 1960 the number of public health nurses employed had been sufficient to 
meet the service needs of the existing programs, but as time went on, new 
positions were needed to serve the increased population and the new programs. 
In 1960 there were 222 public health nurses in the provincial service and by 1970, 
the number had increased to 342. As the decade commenced in 1960 there was a 
total of 490 public health nurses employed in agencies within the province. 
Provincial Service 222 

Metropolitan Health Committee of Greater 

Vancouver 159/2 

Indian Health Service (Federal Health Department) 24 

Victoria, Oak Bay, Esquimalt Health Departments \5Vi 

New Westminster City (part of Simon Fraser Health unit) 8 

Victorian Order of Nurses 61 

The Division of Public Health Nursing was hard pressed as the decade 
advanced to find the funds for new positions and to recruit public health nurses 
for the many vacancies. Few of the public health nurses who completed their 
programs at the University of British Columbia were willing to work in outlying 
or rural parts of the province where most of the vacancies occurred. 



123 



Fortunately federal health grant training funds were still available, so that 
during the sixties over 100 registered nurses became qualified for basic public 
health at university, while 20 qualified public health nurses completed additional 
one year university programs to prepare themselves for senior positions. It is 
interesting to note that 20% of the total public health nursing staff by 1970 had 
received part of their professional education assisted by federal health grants. 
The nurses who accepted bursaries for university education returned to the 
service and became the stable group of public health nurses who formed the 
backbone of the service. 

Recruitment was possible because the service had gained a country wide 
reputation as a good agency where public health nurses were permitted to use 
their initiative, and given the opportunity to advance through proven ability. 
Apart from the public health nursing trainees recruited in the province, public 
health nurses were recruited from other parts of Canada, and Health Visitors 
from Britain helped make up the staff complement. By the end of the decade the 
public health nursing service had developed so that the rural parts of the 
province could now have the same high quality public health nursing service as 
urban and city areas. Some argue that the service was better. 

Some Administrative Changes 

In response to the increase in staff and new programs two consultant positions 
were added in the Division of Public Health Nursing in Victoria during this 
decade. Two well qualified public health nurses who had come through the ranks 
were appointed. Miss Lavinia Crane was appointed in 1961, and Miss Pauline 
Siddons in 1969. 

Miss Crane graduated from the Vancouver General Hospital and the Univer- 
sity of British Columbia with a B.Sc.N. in 1951. She had been a staff public 
health nurse at Squamish and Abbotsford and a Senior Nurse at Chilliwack and 
in the Peace River. As she had completed the M.P.H. degree at the University of 
Michigan with special experience in home care, she was given special responsi- 
bility for this developing program. 

Miss Siddons, a 1 942 graduate of the University of British Columbia course in 
public health nursing had served as a staff public health nurse at Keremeos, 
McBride and Agassiz. She completed the B.S.N, program at the University of 
Toronto, majoring in administration and supervision in 1967, and then became 
supervisor of the East Kootenay Health Unit, followed by the South Okanagan 
Health Unit. As Miss Siddons was particularly concerned with the contribution 
which public health nurses could make to mental health, she was given special 
responsibility for this program which was receiving more attention. Miss Sid- 
dons subsequently completed the M.P.H. degree at Johns Hopkins University. 

The Director, Mrs. Monica Green (Frith) no longer carried a district and was 
concerned with overall planning, organization, budgets, staff recruitment, edu- 
cation, etc. The province was divided into four public health nursing consultant 



124 




■ V 



KINSMEN ' 
HEALTH CENTRI 




New Health Centre. East Kootenay Health Unit. Donna Ross, P.H.N.; Fernie, Mary Kershaw, 
P.H.N. ; Nelson, Pauline Siddons, P.H.N. Sup. Cranbrook "Opening Day" — Natal 1961 

areas. Each consultant visited her area at least twice a year and more often as 
indicated. Through the years travelling had become easier and it was no longer 
necessary for the consultants to be away from their headquarters for three or 
four weeks at a time. In the early days when the consultants had to drive to 
districts such as the Kootenays, it was a two-day trip to reach the destination. 
With air travel it was possible to fly to all parts of the province in a few hours and 
return home on the weekend. However, budgets were limited and great care had 
to be exercised to remain within the travelling allowance. Usually the consultant 
visited more than one unit on each trip. The consultants were well received and 
entertained and became thoroughly familiar with the local situation. Thus they 
were able to present the local public health nurses' point of view in any program 
plans. 

In January, 1962, Dr. G.F. Amyot retired after 21 years as head of the public 
health service which he had carefully developed, based on the concept that a 
good local health service was essential. A guiding principle was that the limited 
funds should be used where it would do the most good for the greatest number of 
people. He was able to obtain budgets for preventive health service which made 
it possible for the public health nursing service to expand throughout the 
province. His continued support and encouragement kept the morale of the 
public health nurses high. 



125 



He was succeeded by Dr. J. A. Taylor as Deputy Minister of the Health 
Branch. With his extensive field experience and 14 years as Director of the 
Bureau of Local Health Services, he understood the many problems which 
public health nurses encountered in their work, and he too gave strong support 
to the Division of Public Health Nursing and individual public health nurses. 
The Division of Public Health Nursing continued as part of the Bureau of Local 
Health Services where broad policies were discussed and liaison made with the 
other divisions and health personnel at regular staff meetings. 

In 1961 the Metropolitan Board of Health of Greater Victoria was formed. 
This was a consolidation of the health services in the area — Victoria City, Oak 
Bay, Esquimalt and the Saanich and South Vancouver Island Health Unit. Miss 
Joan Russell was appointed as the first Director of Public Health Nursing for the 
entire area. The staff continued to be employed locally except in Saanich where 
they continued as provincial employees. 

Home Nursing Expands at Ten Cents Per Capita 

One of the programs to expand was home nursing. The feasibility of adding 
this program to the general service had beendemonstrated in Kelowna, Vernon 
and Saanich. The local cost had been established at ten cents per capita for the 
municipality with the balance made up by the province. Other districts wanted 
the same service but all were not organized so that they could be financed in the 




Isla Tuck, P.H.N., Saanich, changes dressing for senior citizen — 1969 



126 



same way. However it was agreed that a suitable area with a legal description 
such as a fire protection district, a water district or a village could request the 
service under the same plan. The senior nurses and supervisors actively can- 
vassed their districts to assess the need and arranged for local petitions to 
indicate financial support when it was possible to set up a service. This was a 
slow, tedious organizational method as it required house to house canvass. 
However it enabled the program to go ahead with full support. By 1960 there 
were 26 home nursing districts and by 1969 the number had increased to 1 13 
districts receiving home nursing service from 65 health centres. This meant that 
80% of the population within health unit areas now had this service available. 
When the home nursing service provided by the Victorian Order of Nurses was 
added, a total of 92% of the population of the province was now served. Both city 
and rural areas had similar services available. Great credit goes to the senior 
public health nursing staff who expanded the service across the province in little 
more than a decade. Patterns of care were established at this time which formed 
the basis for future expansion. 

First Procedure Manual and Physiotherapist for Home Care 

By 1962 the first home nursing manual was developed by the Public Health 
Nursing Division. It was the first procedure manual suitable for use in the provin- 
cial service and small enough to be carried in the nurse's bag. Up to this time 




0&i£i • « 



Public Health Nurses Ruth McCubbin and Elaine Clarke are assisted in their work by Consultant 
Physiotherapist Kay Thompson — Saanich 1967 



127 



various adaptations of institutional and other agency bedside nursing manuals had 
been tried, which did not always fit the situation. It was revised in 1964 when the 
important section on daily living exercises and rehabilitation were added. 

In 1962 another advance was made with the appointment of the first public 
health physiotherapist. She was Mrs. Christine Leach who was employed on a 
part time basis in the Saanich and South Vancouver Island Health Unit to 
develop a better activation program for patients in the home care program. Her 
job involved teaching public health nurses how to set up and carry out simple 
activation programs. Her approach was so successful that during this decade six 
part time physiotherapists were added in other districts to do similar work. 
Treatment was not part of this service. As time went on the role of the physio- 
therapists expanded and the numbers increased. 

Public Health Nursing Liaison with Hospitals and Doctors 

Liaison with hospitals and doctors too was changing as the population and the 
number of public health nurses and doctors increased in most communities. In 
the early days of public health nursing there was usually only one public health 
nurse in the district, and one hospital so that it was possible to have informal 
discussions with the nurses and doctors concerning the follow up of selected 





Maxine Bolton (Smith). P.H.N. — Oliver 1960 



128 



patients. Most of the public health nurse's concerns had been with new babies 
and a few patients who might require some home supervision. However as the 
home nursing programs developed and patients were discharged earlier for care 
at home regular public health nursing visits to hospitals were necessary. Rather 
than have a number of public health nurses visiting the hospital, one was 
designated as a "liaison nurse" for this purpose. At this time, too, scheduled 
visits to physicians' offices and clinics were instigated to assure follow up of 
patients needing home nursing supervision. 

Involvement with Mental Health Increases 

After medicare was introduced in 1966 it became less time consuming for 
public health nurses to see that needed medical care and treatment for physical 
conditions was arranged. No longer was it necessary to spend a great deal of time 
finding organizations to sponsor the correction of defects such as cleft palates, 
dislocated hips, and vision problems etc. However, many emotionally-based 
problems remained to be recognized and care arranged. 

Because of the shortage of facilities for psychiatric nursing training, a number 
of the older public health nurses had not receive psychiatric clinical experience 
during their basic nursing preparation. Fortunately by 1965 it was possible to 
arrange with the Mental Health Service for the public health nurses lacking this 
experience to complete a two-month special course which included a one-week 
workshop at the Woodlands School on "retardation". In four years 68 public 
health nurses completed the total program while 108 participated in the Wood- 
lands School program. 

This program gave the public health nurses new impetus to tackle mental 
health problems especially in relation to the screening, treatment and care of 
persons with emotional problems. The work with retarded children was espe- 
cially stimulating and public health nurses developed new attitudes of hope and 
helpfulness which they were able to pass on to parents in their districts. As a 
result, many new groups were encouraged to form local organizations and to 
establish new facilities for the education and care of retarded persons such as 
summer camps, schools and special school classrooms. The "making up" of this 
educational deficit had a tremendous effect on the advancement of the total 
mental health program in the province. 

As the Mental Health Branch's new policy was the decentralization of diagno- 
sis and treatment services, new mental health centres were being established 
throughout the province. By 1969, 15 centres had been set up, the majority in 
health unit buildings. This arrangement was made to facilitate easy liaison with 
the new community mental health service. Public health nurses were becoming 
more and more involved with referral, treatment and care of patients as evi- 
denced by 17,310 visits in 1969 utilizing some five percent of their time. 

Miss Pauline Siddons' appointment in 1969 as Public Health Nursing Consul- 
tant with special responsibility for mental health was particularly appropriate at 



129 



this time. She was able to clarify the public health nurse's role in relation to the 
new program and to identify the preventive aspects of mental health which are 
part of basic public health nursing programs. She provided consultation for the 
public health nurses and liaison between the two community nursing services as 
well as arranging special in-service education in mental health. 

More Public Health Nursing Help for the Elderly 

The increased number of elderly people in the general population presented 
many special health problems. As mentioned previously, the home nursing 
service had helped many elderly patients with medical problems to remain in 
their homes. Other "support" services were required, such as "meals on wheels" 
which started in 1 966 in Saanich, the first in a provincial area. It was operated by 
the local social welfare department. Miss Helen McAleese, public health nursing 
supervisor, had encouraged the service and provided a list of "shut-ins" to start 
off the service. It was soon followed by similar services in Nelson, Kamloops and 
elsewhere! 




Public Health Nurse counsels senior citizen 

Homemaker services expanded that same year when special grants became 
available from the Social Welfare Department. As grants did not cover the entire 
cost, many of the public health nurses were active in helping to organize local 
sponsoring organizations. i 



130 




About to attend clinic at Lower Post Indian Reserve, Mile 620 — June 1962 




Prophet River school children waiting for the Public Health Nurse — June 1962 



131 



Other local clubs took on activities such as the "Friendly Visitors" in 
Kelowna. New senior citizen recreation centres were started in a number of 
communities and public health nurses served on many of the boards of these 
organizations. (New Horizons' grants did not come in until much later). One 
outstanding example of a special contribution was the work was done by Mrs. 
Anna Mason, senior public health nurse at Penticton in initiating, with a local 
board, a comprehensive senior citizens' complex which included residential and 
day-care activities. 

"Sixty and Up" clinics were established in some senior citizen centres such as 
Kamloops where special screening was done for hearing, vision, blood pressure 
and other disabilities, as well as general nutrition and health counselling. 

More Indian Reserves Served by Provincial Public Health Nurses 

Seventeen Indian reserves were added in the sixties to those already being 
visited by provincial public health nurses so that they were now providing service 
to thirty percent of the Indians living on reserves. In fact, they were providing 
public health nursing service to over half of the native population, as twenty- 
eight percent of the total Indian population of the province was now living 
permanently "off reserve". A special effort was being made by the federal 
government to extend provincial coverage, as the philosophy at that time was 
that the Indians should have the same health care as the general population. 
Almost all Indian children attended district schools where the provincial public 
health nurses provided the health service. The public health nurses visited the 
reserves regularly, made house to house visits, held clinics, and referred those 
needing more care to appropriate agencies. In fact, more time was needed for 
this group as they had more health problems than the general population. The 
policy caused difficulties in some districts where public health nursing service 
was limited. Most of the new reserves taken over were on the basis of exchange of 
service by federal and provincial public health nurses while service to others was 
billed at $ 1 .25 per capita to the federal government as agreed a number of years 
previously. 

Many new projects were encouraged on the reserves, such as home nursing and 
homemaker courses, recreation, etc. Support was provided as needed by the 
Federal Department of Health and Welfare, Medical Services Directorate, which 
had assumed the responsibilities of the former Indian Health Services in 1963. 

Preventive Programs Expand 

Although primary prevention was still necessary for the protection of the 
public's health, more attention was being directed towards secondary prevention 
— the correction of defects at the earliest possible age. More emphasis was being 
placed on the screening of infants and preschool children by the public health 
nurse to detect mental and physical defects particularly for speech, hearing, 
vision and mental retardation. New techniques were being used in homes, clinics 



132 




Oral Polio Clinic. Silverton school children, Slocan Valley, Myrna Robinson P.H.N. — New 
Denver 1962 




Rural schools visited regularly by Public Health Nurse. Perry Siding school — 1962. Myrna 
Robinson. P.H.N. 



133 




Public Health Nurse screens for hearing loss with audiometer 

and schools for the early identification of defects. Parents were invited to bring 
their preschool children to attend assessment clinics being held at regular 
intervals, all four-year-olds being encouraged to attend. 

The school health program was completely revamped in 1962, following an 
intensive review of the program and consultation with teachers, public health 
nurses, and the Department of Education. Many innovative procedures were 
included as well as some which were already in effect in a few schools. The new 
program set a minimum basic health service for all schools. Miss Alice Beattie, 
Public Health Nursing Consultant, was instrumental in consolidating the mate- 
rial which formed part of the local program manual. It is interesting to know that 
by 1969, the provincial public health nurses were supervising 350,000 school 
children. 

In 1960 the Rheumatic Fever Prophylaxis program, which had been intro- 
duced the previous year on a trial basis in four health units, was expanded to all 
health units. As part of this program, public health nurses supervised children up 
to 18 years of age who had been afflicted with rheumatic fever and placed on 
antibiotic prophylaxis to prevent permanent cardiac damage. 

In 1962 the new oral Sabin vaccine for Poliomyelitis was introduced, and 



134 




Public Health Nurse prepares child for a vision test 




Marilyn Dahl, P.H.N.. vaccinates a school child for smallpox — Saanich 1970 



135 




Public Health Nurse instructs a prenatal class on stages of pregnancy and childbirth — 1972 




Prenatal class attended by lathers and mothers. Victoria Health Centre. P.H. Nursing instructors 
Margaret Baird (Wilson), Margaret McLellan (Acton) — 1962 



136 



public health nurses held "blitzes" throughout the Province for those needing 
protection. 

Immunizations in 1969 amounted to over half a million to children for 
protection against diphtheria, whooping cough, tetanus, poliomyelitis and small- 
pox. Red measles vaccine was added that year and rubella vaccine the following 
year. It was estimated that savings to the British Columbia Medical Plan 
amounted to $750,000 through the administration of antigens by the public 
health nursing staff. 

Venereal diseases continued to increase in numbers and "Speed Zone" epide- 
miology was introduced to try and halt the spread. The objective was to treat on 
epidemiological grounds before the diagnosis was confirmed, thus eliminating 
possible further spread of the infection. Public health nurses in some high 
incidence areas such as Prince Rupert always carried oral penicillin with them so 
that they could dispense it as they made their rounds. 

Expectant parent classes continued to be popular, particularly for first-time 
parents when both mother and father would attend evening classes. Classes were 
also available during the day for mothers only, as well as for single or adopting 
parents as warranted. By now the scheduled evening work was creating "over- 
time" problems, but most health units gave equivalent time off to the public 
health nurses working in the evenings. 

A new poison control program had been set up, with the centre in the local 
hospital. Public health nurses were asked to do follow up in the homes to help 
establish home safety in situations of accidental poisoning. 

Research Studies in Public Health Nursing 

Although the Public Health Nursing Division had much statistical data on the 
activities of public health nurses it was becoming increasingly difficult to mea- 
sure the results of their work in terms of reduction of disease, etc. No longer were 
dramatic effects being shown from the control of communicable diseases 
although continued vigilance was necessary to keep the community protection 
level high. The public health nurse was no longer the only community health 
worker as social workers, school counsellors, psychologists, etc. were involved 
with many of the same families as the public health nurses. 

To help clarify the results of the public health nurses' activities a number of 
research studies were initiated. Encouragement and stimulation in research 
methods came from Dr. Donald Anderson, Professor of Epidemiology and 
Research, University of British Columbia Health Sciences who conducted a 
series of correspondence courses and workshops for public health nurses under 
the sponsorship of the Public Health Nursing Council's Education Committee. 

By 1965 the public health nurses had tried small studies and had become 
interested in more research when a major study was undertaken to measure the 
effectiveness of the public health nurse's family visits. Similar studies had been 
conducted in the United States under the sponsorship of the Department of 



137 



Health, Education and Welfare who kindly made their Western Nursing Consul- 
tant, Miss Hazel Shortal available for consultation. Miss Lavinia Crane, Public 
Health Nursing Consultant, directed the "Patient Progress Study" which 
involved 36 public health nurses in six health units over a six month period. The 
results showed that the public health nurses met their objectives and that their 
work was effective although less easy to measure than in the past. 

A comprehensive mental health study was done in 1966 to determine how 
involved the public health nurses had become in selecting patients for referral to 
mental health clinics and in subsequent follow up. The study demonstrated the 
importance of the public health nurse in case finding as she selected over forty 
percent of the patients seen at clinics, and referred another thirty percent who 
had been brought to her attention by colleagues such as teachers, counsellors etc. 
This study showed that the new mental health involvement would justify the 
addition of public health nursing staff. The study did not include the traditional 
preventive aspects of mental health incorporated into other basic programs. 

Other projects included small studies of various aspects of the school health 
program with every health unit participating. Also Boundary Health Unit 
conducted an extensive study on vision testing of children. South Okanagan 
Health Unit studied selection methods for follow up of preschool children 
through the use of special criteria at child health conferences. 

The public health nurses were generally very interested in participating in 
studies and conducted many small studies that resulted in improved policies and 
procedures. 

Health Unit Aide Service Expands 

Public health nurses' time studies had repeatedly shown that they were spend- 
ing too much time (about 4-5%) on certain non-professional activities that were 
necessary to get the work done, such as cleaning, sterilizing, or autoclaving 
nursing and medical supplies. There was no one else to do these jobs. It had been 
pointed out by study teams such as Baillie and Creelman in 1950, and Beattie and 
Page in 1956, that this was poor use of public health nursing time. It had not been 
possible to persuade government officials to expand the aide program intro- 
duced in Saanich and Boundary Health Units in 1957. As the immunization and 
home nursing programs accelerated with the increased population, the funds 
were finally available and in 1962, health unit aide service was instituted in all 
health unit offices. The aide positions were part time based on a ratio of seven 
hours of service per public health nurse per month. Part time help was readily 
found, and the aides took pride in their work and by giving it their undivided 
attention maintained a high standard. In some smaller offices the part time clerk 
added the aide work to her clerical duties. 

By the time disposable sterilized equipment was introduced in 1966, the health 
unit aide service was well established. About this time, the "baby boom" children 
filled the schools and created an unprecedented need for immunizations and 



138 



other services. In 1968, trials were conducted to determine whether carefully 
selected and oriented health unit aides could carry out routine tests such as 
vision and hearing screening on children in schools. They proved capable and by 
1971 health unit aide activities were increased to take over some of the routine 
work outside the health unit office. This gave the public health nurses more time 
to concentrate attention on the children screened out for further follow up. Miss 
Alice Beattie, Public Health Nursing Consultant, advised on the studies and 
supervised the introduction of the health unit aides. 

Institute and Other Staff Education Changes 

By the late sixties the Public Health Institute had gone through many adapta- 
tions. It had moved from the Empress Hotel in Victoria to the Georgia Hotel in 
Vancouver and then to student residences on the campus of the University of 
British Columbia. The new setting accentuated the "Continuing Education" 
aspects of the meeting, and offered better facilities for the larger number of staff. 
The format had changed from one key speaker to carry the main theme, to fewer 
outside speakers and more group sessions and local specialists. The public health 
nursing section meetings featured more field reports from staff nurses, and 
pertinent nursing developments. Seniors and supervisors held their own special 
meeting one day prior to the three day Institute to discuss their particular 
problems. The Institute had become so large that the traditional dinner had been 
abandoned. However it was still an exciting time for the public health nurses to 
get together with their friends, to find out about other districts and to plan for 
possible transfers, etc. Opportunities were made available for meeting with the 
Director and Consultants. The Institute provided an excellent opportunity to 
know what was happening in public health both at home and elsewhere. 

In addition to the one day Senior Meeting a "workshop" was arranged every 
three years for the seniors and supervisors to help meet their special educational 
needs. In 1963, Dr. Ruth Freeman, Johns Hopkins University School of 
Hygiene led a one week course on supervision techniques as related to public 
health nursing at the Grosvenor Hotel in Vancouver. Three years later she 
returned to give a one week course in administration to the supervisors and 
medical directors. In 1970 Dr. Loretta Ford, Professor from Colorado Univer- 
sity, gave another stimulating workshop on "Expertise in Public Health Nur- 
sing". Senior nursing staff from the Greater Vancouver and Victoria Health 
Departments were included. 

Staff and senior public health nurses also participated in a limited number of 
suitable short courses at Department expense, as they became available at the 
University of British Columbia's Continuing Education Department. 

Federal-Provincial Public Health Nursing Consultation 

The first Federal-Provincial Public Health Nursing Meeting was held in 
Ottawa in the late fifties, chaired by Miss Dorothy Percy, Principal Nursing 



139 



Officer, Department of National Health and Welfare, and attended by all the 
provincial Directors of Public Health Nursing or their representatives, and the 
Federal Nursing Consultants concerned with public health nursing programs. 
These meetings provided an opportunity for the directors to learn at first hand 
about the services available to them from the Federal Department of Health and 
Welfare, and at the same time gave the federal participants specific information 
about the provinces. Miss Esther Robertson, Consultant in Maternal and Child 
Health, Miss Evelyn Pepper, Consultant in Civil Defence, and Miss Mildred 
Walker, Consultant in Occupational Nursing attended the first sessions. Ar- 
rangements were eventually made for all three consultants to visit and conduct 
workshops in British Columbia. At the first meeting the directors presented 
provincial program reports, which were updated at the subsequent meetings 
held annually. New developments and much "how to do" information was 
exchanged. At later meetings specific programs were selected for review. In 1972 
Miss Olivette Gareau, an experienced public health nurse and educator, was 
appointed to replace Miss Percy. She realized that better communication 
between nursing groups was indicated, and instituted joint federal-provincial 
meetings attended by provincial representatives of community health, hospital 
and Federal Health Services. These meetings resulted in better relationships 
between the three groups, more co-operation in in-service education, and greater 
participation in planning on a federal level. As a result of the meetings with 
public health nursing directors, Miss Gareau, Director of Community Health 
Services initiated a provincially represented "Advisory Committee on Commun- 
ity Health." The meetings also tended to standardize and improve the quality of 
public health nursing programs across the country. They were particularly 
helpful to provinces whose public health nursing services had developed slowly. 
British Columbia was able to offer some consultant service, particularly on 
home care services, to other provinces as a result of discussions at the meetings. 
Workshops were conducted in Saskatchwan by Mrs. Monica Green in 1966, and 
continued by Miss Lavinia Crane. Later Miss Crane visited and provided 
detailed guidance for the development of the home care programs in Prince 
Edward Island, Nova Scotia, and New Brunswick. 

The Sixties End 

The sixties came quietly to an end with no single event marking their demise. 
By this time the British Columbia Public Health Nursing Service was considered 
a leading public health nursing organization with a strong field and administra- 
tive staff. Many former public health nurses were making, or had made, impor- 
tant contributions to the development of nursing and public health at home and 
elsewhere. To mention a few, Miss Eleanor Graham had been Executive Direc- 
tor of the Registered Nurses' Association of British Columbia, followed by Miss 
Nan Kennedy. Mrs. Janet Bailey (Pallister) was Director of Public Health 
Nursing in Alberta; Mrs. Margaret Jackson (Campbell) was on the Nursing 



140 



Faculty of the University of Alberta; Miss Margaret Cammaert was Consultant 
with the Pan-American section of the World Health Association; Miss Jessie 
McCarthy and Miss Kirsten Weber were on the faculty of the University of 
British Columbia in the Departments of Health Care and Epidemiology, and 
Nursing respectively. Miss Dorothy Kergin was at the University of Michigan in 
preparation for the position which she would have as Assistant Dean of the 
School of Nursing at McMaster University, and later Director of the School of 
Nursing at the University of Victoria. Many, too, were making special contribu- 
tions to the community. Miss Joan Appleton (Norris) was awarded the "Free- 
dom of the City" of Penticton, for her special activities and later became the first 
woman on the British Columbia Board of Parole and alderman of Pitt Meadows 
Municipality. Miss Vera Andrews was alderman of Cranbrook, while a number 
of other public health nurses became active on local school boards. Miss Trenna 
Hunter, who had been Director of Public Health Nursing for the Metropolitan 
Health Committee of Vancouver was granted honorary membership in the 
Canadian Public Health Association for her outstanding contribution to public 
health nursing. 



141 



VII. THE SEVENTIES BEGIN 



143 



The Seventies Begin 

The province continued its strong growth pattern in the seventies. By 1 97 1 the 
population was close to 2,200,000 which was just about double the population of 
twenty years earlier. Many small villages had become cities and urban centres. 
New public health nursing services were required in "instant towns" such as 
MacKenzie and Sparwood. Over the years the concept of health as concerned 
only with disease prevention and control had broadened so that the public now 
understood that health services included community programs which would 
minimize hazards that generated morbidity and mortality. Public health nursing 
had continued to expand its outlook to include new areas of concern due to the 
changing health needs of the population, now threatened with new technology, 
chemicals in the environment and family and lifestyle changes. 

Hospital Days Replacement Program Initiated 

The seventies started on an optimistic note with a "breakthrough" in the home 
care program. Although it had been pointed out repeatedly that the existing 
program was saving the government a great deal of money (at least $166,000 
estimated for limited service in 1970), the Division of Public Health Nursing 




Diane Ouston, Snr. P.H.N, visits a patient in hospital prior to admission to the home care program 
— 1970 New Westminster. 



144 



believed that more could be done with more staff. This had been demonstrated in 
the 1950's in the Vernon pilot program. By 1970 the cost of hospital beds had 
greatly increased, and the Royal Columbian Hospital in New Westminster was 
extremely short of hospital beds. The home care program in the Simon Fraser 
Health Unit was doing its best to accept as many patients as possible from the 
hospital. The potential for more was there with the addition of more nurses and 
auxiliary or support services. In 1 970, Mrs. Diane Ouston, Senior Public Health 
Nurse in the Simon Fraser Health Unit was in charge of the home care program 
and also president of the Public Health Nursing Council. As was the custom, she 
and other members of the Council as well as the Director of Public Health 
Nursing met with the Minister, the Honorable Ralph Loffmark to discuss the 
general public health nursing service. He was particularly interested in the home 
care program and the potential for making better use of existing hospital 
facilities. He asked Mrs. Ouston if she could set up a program in her Health Unit 
if she had the necessary funds, in order to show that home care could be as good 
as hospital care for selected patients. She immediately accepted the challenge 
and with the assistance of Miss Lavinia Crane, Public Health Nursing Consul- 
tant and the senior staff of the Health Unit, Miss Barbara Smith, Public Health 
Nursing Supervisor, and Dr. J. Munroe, the program got under way in 1970. 
Both hospitals in New Westminster were involved, the Royal Columbian and St. 
Mary's. 

By the end of the first year it was shown that the cost of the comprehensive 
home care program which included nursing, physiotherapy, drugs, homemak- 
ers, meals on wheels and supplies as indicated was one quarter of the cost of 
acute hospital care. The new program was called the "Hospital Days Replace- 
ment Program" and patients could have this service without charge for the 
equivalent number of days that they would have been in hospital. Those patients 
needing care over a longer period were transferred when their term expired to the 
regular public health nursing service program. They then had to pay for services 
required other than nursing. As might be expected this service was utilized by 
people in all age groups with 63% being under 65 years of age. 

Home Care Programs Increase and Co-ordinators Appointed 

Home Care Co-ordinators were appointed to set up similar hospital days 
replacement programs in 1972 in two different communities. Kamloops and 
Victoria were approved for further study and Miss Betty Short was appointed to 
Victoria and Miss Kathy Iszatt to Kamloops. These were big undertakings as 
new full and part time nurses had to be employed, equipment procured, and in 
some situations homemaker and food service to be organized, as well as liaison 
with other professionals, etc. Assistance came from the supervising nurses and 
directors of the health units while Miss Lavinia Crane, Public Health Nursing 
Consultant responsible for home care, provided guidance as well as assistance 
with in-service education as required. The three projects were carefully moni- 



145 



tored in the Division of Public Health Nursing before further expansion took 
place. This occurred very rapidly and by 1974 the Hospital Days Replacement 
Program was available in all large and medium-sized communities to 80% of the 
population. 

By June 1974 the Health Department had integrated the Victorian Order of 
Nurses branches of the Greater Vancouver and Victoria areas into the service 
and in 1975 included the remaining Surrey branch. Thus there were no charges 
being made directly to the patients for nursing care prescribed by a physician. In 
1973 Mrs. Diane Ouston returned from completing the M.P.H. degree at the 
University of Michigan with special experience in home care and became 
responsible for the total home care program. By 1974 the regular organized 
home care and the hospital days replacement programs were consolidated. Each 
area then had a full time home care co-ordinator. 

Public Health Nursing Liaison Increases 

Public health nursing liaison had become more structured as the number of 
physicians increased in the community. In formal visits to the hospital the liaison 
nurse attempted to see physicians regarding home follow-up of patients needing 
care. Also in a number of communities the liaison public health nurse made 
routine visits to physicians' offices and clinics. In 1974, the Annual Report 
indicated that public health nurses made 7,464 routine visits to physicians' 
offices, 6,623 visits to general hospitals and 8,507 visits to other agencies on 
behalf of persons receiving care from the public health nurse. Liaison and 
co-ordination of service continued to be an integral part of the public health 
nurse's work. 

More Experimental Programs 

In the early seventies, a number of the health units took advantage of Local 
Initiative Program (L. LP.) grants and student grants to enrich local services for 
handicapped, elderly and disadvantaged people in their communities. For 
example, in the Selkirk Health Unit the public health nurses helped organize a 
program of recreation, outings, and special dinners for senior citizens. These 
projects showed what could be done and paved the way for other organizations 
to continue these services with partial support from New Horizons grants. 

About this time public health nurses also used the opportunity for "lay" 
assistance provided by "Incentive Trainees", (Welfare recipients being reintro- 
duced to activities outside the home). 

Health Promotion Adds New Dimensions 

The promotion of health had always been one of the major objectives of the 
public health service. In the late sixties and early seventies it became clear that 
the prevention of disease by broad health measures such as the provision of safe 
water, milk and food, plus immunization programs, medical, nursing and phar- 



146 



macy care, etc. was not the complete answer to positive health. More concern 
was being expressed by the general public on the need to improve the quality of 
life, and the fact that much more individual effort was needed to maintain and 
improve health. The machine age had reduced the need for physical exertion, 
leaving more leisure time and flabby muscles. Accordingly, much of the public 
health nurse's educational efforts were now directed toward encouraging more 
individual effort to improve health through such measures as more exercise, 
better nutrition etc. Drug and alcohol control and safety education were stressed 
in individual counselling and in group sessions. 

Renewed Emphasis on Preschool Assessment 

More emphasis was being directed toward special preschool clinics for 3 and 
4-year-old children. New screening methods to test for deviations from the 
normal had become available such as the Denver Developmental Screening Test 
designed for nurses to test motor, language, and personal-social development. 
There was also new vision and hearing testing equipment. Early treatment can 
contribute to future progress and prevent the serious effect of deviations from 
the normal and resulting costly treatment. The new tests and follow up care 
learned by the public health nurses during in-service education, were being 
utilized- in the increased number of special clinics for preschool children. 




Public Health Nurse Janice Sturdy administers the Denver Developmental Screening Test 



147 



Public Health Nursing Community Care Co-ordinators Appointed 

As public health nurses became more involved in the care of the elderly in their 
homes they found that they had a contribution to make to the care of the elderly 
in community care facilities. Up to this time most of the facilities were "personal 
care" homes, small and privately operated. Most of the operators were non- 
professionals concerned not only with care but with making their facility pay. 
They were generally known as "Rest Homes" or "Boarding Homes for the 
Elderly." Although they were licensed for ambulatory persons only, many of the 
residents needed some nursing care. Occasionally public health nurses were 
called on to give the care they might give in a private home. Extended Care Units 
in general hospitals or Intermediate Care homes as known today did not exist. 
There were a few private nursing homes in the larger centres. The first govern- 
ment built institutions for personal and intermediate care were completed in 
1973. 

In 1969, the Health Branch first became involved in the licensing of commun- 
ity care facilities when it was represented on the interdepartmental Licensing 
Board. The Licensing Board determined the suitability of the institutions giving 
care to adults and children and issued appropriate licenses. By 1971 the Health 
Branch became responsible for the Community Care Licensing Act. The inspec- 
tion of facilities in the community then passed on to the health units, and public 
health nurses became officially involved in the quality of care being given in 
these institutions. Previously public health nurses had been visiting many of the 
personal care homes to encourage recreation and activation programs and to 
advise on general health care and sanitation. They assisted with meal planning 
supported by provincial nutritionists. They also encouraged volunteer groups to 
take on special projects. If a physiotherapist was available she might set up the 
activation program. In 1969, public health nurses were making 1,000 visits per 
year to personal care homes and the numbers of visits tripled by 1975. As day 
care facilities for infants and preschool children were covered by the Act, public 
health nurses encouraged improvements in conditions when they visited these 
centres. Here, they found a captive audience for much early screening for defects 
such as impaired vision and hearing. 

Eventually it proved to be most efficient to have one experienced public health 
nurse in the health unit with special interest in this type of care take responsibil- 
ity for the program. She became known as the "Community Care Co- 
ordinator." 

Public Health Nursing Uniforms Become History 

The public health nursing standard uniform as introduced in the late forties 
continued, with minor modifications, to conform to current fashions. The suit 
was still being worn, with the length of the skirt and jacket changing with the 
times. In the sixties when mini-skirts were popular some public health nurses 
shortened their skirts to "mini." In 1970 a light blue color replaced the darker 



148 



blue. As variety and change was the mark of the sixties, it carried over into 
uniforms. A variety of blouse styles were worn. When women started wearing 
pant suits to work in the early seventies this style too became optional for public 
health nurses. The "American Golfer" had been the original summer uniform 
dress. Other light blue dresses were tried until 1960 when blue and white 
pinfeather was introduced. The crisp washable dress with hat to match, was most 
attractive in both the one or two piece styles. The navy blue gabardine coat 
remained standard although it was cut along straighter lines as the fashion 
dictated. By 1971 the color changed to light blue with a choice of material in 
Harris Tweed or gabardine. 

Hats became a problem as new high hair styles such as the famous "beehive" 
became popular in the sixties. In 1960 the "Glengarry" had been replaced by a 
"pillbox" with a small woven insignia replacing the large gold pin. Hats were 
being worn less and less and by 1971 they were declared optional. A white toque 
or tarn was worn in the winter with a white scarf. 

The public health nurses looked very smart in their summer and winter 
uniforms. In the sixties freedom from conformity became a dominant force and 
some nurses particularly the young staff members, saw the uniform as detracting 
from their individuality, as well as being a symbol of authority. This trend was 
evident- in a number of hospitals where nurses no longer wore uniforms as well as 
in the Mental Health Clinics where mental health nurses did not wear uniforms. 
Another factor was cost. In 1974, the uniform suit cost less than sixty dollars and 
the coat, eighty. The initial uniform grant of $150.00, more than covered the 
basic cost, while an allowance of $100.00 was available each year for the 
purchase of a major item. Some nurses felt the cost of all items should be 
covered. 

In 1974 the public health nurses first contract with the government was signed, 
and the uniform allowance was given up in exchange for salary parity with 
institutional nurses and other benefits. When the uniform was discontinued in 
1975 a tradition of fifty years ended with the blue uniform no longer the symbol 
of public health nursing in the provincial service. 

Staff Education Program Adjusts to Increased Numbers of Public Health 
Nurses 

By 1972 there were over 600 full time staff in all categories in local health 
services and it was no longer feasible for the annual Public Health Institute to 
provide the major staff education program for such a large multi-discipline 
group. Over 300 public health nurses were employed as staff, seniors, and 
supervisors, in addition to the many registered nurses involved solely in the 
home care program. A new plan of regional institutes and workshops was 
introduced as an alternative. 

Regional or mini-institutes commenced in 1972 for staff public health nurses. 
Three regions were established with the plan to hold a regional institute each 



149 



year. Each public health nurse attended the institute in her region. On interven- 
ing years she had the opportunity of participating in a suitable educational 
program offered by a university college, or health agency, or another regional 
institute. In this way one special educational program was available to every 
nurse every year. 

The first regional institute was held in Kamloops in the main office of the South 
Central Health Unit and proved so successful that the plan proceeded. Facilities 
were excellent in the new building with its theatre style auditorium which was the 
right size for the participants. Mrs. Kay Marshall, Public Health Nursing Super- 
visor, and the public health nurses looked after local arrangements, while the 
program itself was set up by the Division of Public Health Nursing following the 
usual questionnaires to the staff regarding their wishes. There was a return to the 
traditional hospitality hour and dinner with entertainment. Everyone had a good 
time and enjoyed the informality of the smaller group. 

As each health unit had sent at least one official representative it was possible 
to arrange a meeting of the Public Health Nursing Council in the evening. 

The following year, in 1972, the Fraser Valley Region held its institute in 
Vancouver, utilizing the facilities of the Christmas Seal auditorium in the 
Tuberculosis Pavilion. The third year the institute was held in Victoria for the 
Vancouver Island public health nurses at the Newcombe auditorium of the 
Provincial Museum. 

Also in 1 972 it was arranged that all senior staff would meet for educational 
purposes once a year. The first meeting was held at the University of British 
Columbia in one of the residences after the winter session finished. Medical 
health officers, dental officers, public health inspectors, senior clerks, senior and 
supervisory public health nurses and specialized public health workers all 
attended. Apart from joint opening and closing sessions, the public health 
nursing supervisory staff met together to discuss matters related to their special 
responsibilities. The senior staff meetings were held annually and were open to 
the senior staff of the official Vancouver and Victoria health services. 

Other educational meetings were arranged on a special basis for home care 
workers and community care co-ordinators, as the numbers warranted. 

The new educational plan seemed to meet the in-service education needs of the 
public health nurses at that time. 

Changes in the Educational Preparation of Public Health Nurses 

The Department of Nursing and Health at the University of British Columbia 
was the only institution within the province to prepare nurses for public health 
nursing. In the early years of the program which started in 1919 the number of 
graduates kept pace with employment opportunities. However, as the popula- 
tion increased the number of graduates was insufficient to meet the increasing 
needs of the province. The degree program in nursing was preparing nurses for 
public health nursing, as well as teaching and hospital administration. 



150 





1940 Graduates of B.A.Sc in Nursing Program 
- U.B.C. 



Department of Nursing University of British 
Columbia Faculty. Miss Mabel R. Gray (centre). 
Professor and Head Miss Margaret Kerr (L) and 
Mrs. Geraldine Langton (Homfray) (R), instruc- 
tors of Public Health Nursing in front of the 
Science Building 1940 



The. university made a number of administrative changes to improve the 
education of students as well as to encourage enrolment in the nursing programs. 
In 1951 the University of British Columbia School of Nursing was formed as a 
near autonomous unit within the Faculty of Applied Science. The eventual goal 
was to have all basic nursing education under the direction of the School of 
Nursing. The B.S.N, degree replaced the B.A.Sc. at that time. However, the 
program remained a long one, consisting of three years on campus, and almost 
three years of clinical hospital experience and lectures. The diploma course was 
still popular for registered nurses wishing to become public health nurses. Many 
who had qualified by a diploma in public health nursing were anxious to obtain a 
degree but this was a long process. By 1958 the School of Nursing undertook to 
integrate university and hospital experience by providing the basic instruction 
and clinical supervision. A gradual shift was made in student experience from 
the Vancouver General Hospital to St. Paul's Hospital until by 1961, all hospital 
clinical experience was at St. Paul's Hospital. Public health nursing experience 
continued to be provided by health units throughout the province and in the 
Vancouver area in blocks of two to four weeks. The field guides were expe- 
rienced public health nurses on staff, who planned and supervised the students' 
day to day practice in public health. The program was gradually modified and 
reduced to a total of five years. Concurrent field experience was introduced on a 
year-round basis. It was then necessary to utilize health services adjacent to the 
University so that the students could commute weekly for their field experience. 
Health units in the Vancouver area and the lower Fraser Valley were suitable 
training areas. As all students were required to have public health field work, a 



151 



number of public health nurses were spending a great deal of time on "educat- 
ing" students when they had been employed primarily for service. The university 
gradually eased the burden by supplying additional field guides. Block field 
experience of four weeks continued to be provided in other health units for 
students wishing broader public health experience. 

Public health nursing had become increasingly complex and the education 
offered in the degree program was the preferable preparation for public health 
nurses. Many public health nurses who had qualified for public health nursing 
by the diploma course or health visitors' course were returning to university 
making determined efforts to obtain a degree in nursing. 

By 1972, a major stumbling block to the recruitment to the nursing degree 
program was overcome when suitable high school graduates were accepted 
directly into the program. Prior to this it was necessary to have completed the 
equivalent of first year university. This reduced the length of the program to four 
years (from five) and provided a program similar in length to other professional 
programs being offered university students. This change greatly increased the 
enrolment of students from high school as well as the number of registered 
nurses eligible to improve their academic standing. 

The University of Victoria had contemplated a nursing degree program for 
many years and by 1975 began setting up a program for registered nurses. In 
1976 the first class of sixty nurses was enrolled in the B.Sc.N. program which 
would take them approximately two years. 

At last there were two universities preparing nurses for public health practice 
and the Division of Public Health Nursing could look forward to employing well 
prepared nurses to meet the challenges of the future. 

Public Health Nurses Attain Bargaining Rights 

In 1972 all civil servants (soon to be known as public servants) were given the 
right to form a union to bargain with the government concerning salaries, fringe 
benefits, etc., along with the right to strike. This eliminated the presentations of 
the Personnel Practices Committee of the Public Health Nursing Council as the 
spokesman of the public health nursing group. Public health nurses now became 
a part of the British Columbia Government Nurses' bargaining unit, and were 
permitted as a professional association to bargain as part of a nursing group. 
This group consisted of all nurses in the government service, both institution and 
community- based. The first negotiations took place in 1974 at which time a 
professional negotiator from the Labor Relations section of the Registered 
Nurses Association represented the nurses and was spokesman for the selected 
nursing representatives. Only Nursing Directors were considered "Manage- 
ment" and excluded in the first contract, although in subsequent contracts it was 
possible to exclude more senior staff. Benefits in the first contract settlement 
finally gave the staff public health nurses salary parity with hospital staff, along 
with such items as improved travel allowances, recognition of overtime etc. 



152 



Uniform allowances were lost. Public health nurses accepted union membership 
with mixed feelings. Naturally they were pleased with the benefits which now 
helped recruitment and staff stability. 

Changes in the Division of Public Health Nursing to the Mid-Seventies 

i nree long time members of the Division of Public Health Nursing retired 
after an extended period with very few changes. The first to leave was Miss Alice 
Beattie who had begun her career in Dr. Young's time in the Cowichan Health 
Centre. As a consultant Miss Beattie will long be remembered for her contribu- 
tion to expansion and administration of the clerical service, the introduction of 
health unit aides and the development of the new school health program follow- 
ing local research studies. Miss Beattie completed a total of 35 years of varied 
and dedicated service, resigning in January, 1974. 

Soon after, in July 1975, Mrs. Dorothy Slaughter retired after 35 years to her 
credit. Mrs. Slaughter's first appointment had been to the first provincial health 
unit in Saanich, while the first Health Officer, Dr. D. Berman was still the 
Director. Mrs. Slaughter's contributions as the second Public Health Nursing 
Director have been noted. Her many activities as liaison officer with the Van- 
couver Divisions and voluntary agencies contributed to general program devel- 
opment. The St. John's Ambulance Association officially recognized her work 
when they invited her to Ottawa in 1962 to be invested by Governor General 
George Vanier as a sister in the Order of St. John's Ambulance. 

In December 1975, Mrs. Monica Green resigned after 35 years service of 
which 30 years were in the Public Health Nursing Division as Consultant and 
Director. She had seen the service grow in three decades, from a time when there 
were fewer than fifty public health nurses in the provincial service to around 340 
at the time of her retirement. She was honored in 1967 to be made a Fellow of the 
American Public Health Association, and given an honorary membership in the 
Canadian Public Health Association following her retirement. 

Miss Lavinia Crane, Assistant Director of Public Health Nursing, was 
appointed Director of Public Health Nursing in December, 1975. As noted 
previously Miss Crane was a long time member of the staff, having been in the 
Division since joining as a consultant in 1961. Well qualified professionally and 
personally she was a popular choice. 

Fortunately there were well qualified public health nurses available for the 
other consultant positions which came open. The first was Mrs. Diane Ouston, a 
1959 graduate of the B.S.N, program of the University of Alberta. She had 
joined the service as a staff nurse at Kamloops and had been a Senior Nurse in 
the Simon Fraser Health Unit where she had the major responsibility for setting 
up the demonstration Home Nursing Care program. Prior to accepting the 
position she completed the M.P. H. degree from the University of Michigan. She 
was appointed Consultant in September, 1973. 

Mrs. Margaret Wilson (Baird) was appointed in September, 1974 to a new 



153 







Public Health Nursing Division: Lavinia Crane, Asst. Director P.H.N.; Diane Ouston, Consultant P.H.N.; Monica Green (Frith), Director P.H.N.; 
Margaret Wilson (Baird), Consultant P.H.N.; Pauline Siddons, Consultant P.H.N. Inset: Dorothy Slaughter (Tate), Consultant P.H.N.; Alice Beattie, 
Consultant P.H.N.; Joyce Winters, Consultant P.H.N. — mid 1970s 



consultant position on her return from Ontario where she had been on the 
teaching staff of the University of Windsor School of Nursing. She had pre- 
viously been a staff nurse in Saanich and a supervisor in the West Kootenays at 
Trail. She had graduated from the University of British Columbia with a B.S.N, 
in 1961, with the M.N. from the University of Washington and M.P.H. from the 
University of Michigan (1974). 

Mrs. Joyce Winter B.Sc.N. from Western University, London, Ontario was 
appointed in August, 1974 to the Vancouver centered public health nursing 
consultant position. Her previous experience had included work with the Victo- 
rian Order of Nurses in Ontario, and appointments since 1955 in Boundary- 
Health Unit as a staff and Senior Nurse, as well as Senior Nurse in Simon Fraser 
Health Unit. 

The staff changes took place smoothly and the Division of Public Health 
Nursing continued to function as a well rounded unit working well with the 
central office administration and the field staff. A major adjustment was the 
advent of the Union which required new routines as all public health staff were 
now members of various groups which had slightly different guide lines. 

Conclusion 

The years have shown that the work of the community based public health 
nurse has changed somewhat, and that over the years some health problems have 
been solved, while others have been alleviated by health and social benefits. New 
problems have arisen, largely due to new technology, increased longevity, and 
larger numbers of people crowded into smaller spaces. The public health nurse's 
work has shifted to meet these new challenges. However much remains the same 
with new application. Reports of the seventies such as those of the Canadian 
Public Health Association Task Forces and the Foulks Report of 1973 stated 
that more preventive health services are needed. The present level of preventive 
service must be maintained and expanded through innovative approaches to 
solve the new health problems. Public health nurses will need to continue to 
modify their programs to meet changing situations. Through the years they have 
demonstrated that they can set high standards of achievement which stand as a 
challenge to those who follow. 



BIBLIOGRAPHY 

Amyot. GF. Some Historical Highlights of Public Health in Canada. Presented to the Canadian 

Public Health Association, April. 1967. 
Annual Reports. The Provincial Board of Health 1911-1945; The Department of Health and 

Welfare. Health Branch 1946-1958; The Department of Health Services and Hospital Insurance. 

Health Branch 1959-1974; The Department of Health 1975. 
Beattie, Alice. Let's Look at School Health Services. Can Nurse. Now. 1964. 
Benson, K.1G; Beattie Alice. A New Approach to the School Health Program. Canadian Journal of 

Public Health, 1964, 55:371. 
Blatherwick, J. History of Public Health in British Columbia. F.B.J. Publication. 1980. New 

Westminster 

155 



Can PH Assoc. Report on the Study Committee on Public Health Practice in Canada. Toronto, 

1950. 
Correspondence. Cawston, Betty. Feb. 81. Vancouver, B.C.; Gareau, Olivette, May 82. Director 

Community Health Services, Dept. of Nat. Health and Welfare. Ottawa, Ont.; Kilpatrick, 

Heather, June 81. Vancouver, B.C.; Langton, Geraldine, June 81. Langley, B.C.; McCann, 

Elizabeth, Feb. 81. Vancouver, B.C.; McVicar, Jean, Sept. 81. Nelson, B.C.; Priestly, Dorothy, 

June 80. Nanaimo, B.C.; Quayle, (Murray) Ann, Aug. 79. Nanaimo, B.C.; Williams, June, Aug. 

81. Langley, B.C.; Wisby (Staniforth), Majorie, April 81. Vernon.; Yaholnitsky, Pauline, March 

80. Vancouver. Williamson, Eva, Oct. 83, Vancouver. 
Crane, Lavinia M. A Design for Home Care. Can. Nurse, Vol. 60, No. 1 1, Nov. 1964. 
Esquimalt Rural Nursing Service. A Summary of the Work of the Association/or the Information of 

Its Supporters. Mrs. C. Brown, Secretary, Treasurer, 1926. 
Files. Duncan Office. Central Vancouver Island Health Unit, Ministry of Health. 
Frith, Donald. Insignia pin illustration. 
Gibbon, John Murray. The Victorian Order of Nurses for Canada Fiftieth Anniversary. Montreal, 

Southam Press, 1947. 
Green, Monica M. The Expanded Role of the Public Health Nurse. Can J Public Health 62:147, 

1971. 
Hamilton, James, and Associates. Report on Hospital Services in British Columbia. Dept. of Health 

and Welfare, 1949. 
Langton, Geraldine, Kilpatrick, Heather, Upshall, Muriel, Tape Recording. 1980. 
Kornder, LD; Nursey Joanne, Pratt-Johnson, J. A., Beattie Alice. Detection of Manifest Strabismus 

in Young Children. Am J Ophthomology, Feb. 1974. 
Ormsby, Margaret. British Columbia: A History. Vancouver: Evergreen Press, 1958. 
Pictures from: Beattie, Alice; Bond. Aileen; Graham, Florence; Gerdes, Elsie; Kilpatrick, Heather; 

Lee, Nancy; Piket, Gladys (Skinner); Priestly, Dorothy; Quayle, Ann (Murray); Robinson, 

Myrna; Smith, Maxine; Wilson, Margaret (Baird); Wisby, Marjorie (Staniforth). 
"A Study of Patient Progress." Conducted by the Division of Public Health Nursing B.C. Dept. of 

Health, Aug. 1966. 
"Public Health Nurse's Bulletin". Issued by the Provincial Board of Health, 1928-1938. 
Public Health Nursing Council Meeting Minutes. 1943-1974. 
Report on the Study Committee on Public Health Practice in Canada. Canadian Public Health 

Association, 150 College St., Toronto, June 5, 1950. The study was made possible through the 

assistance of the W. K. Kellogg Foundation Battle Creek Michigan. 
Report. The Division of Vital Statistics. The Ministry of Health. Report 1 976. The Division of Vital 

Statistics Department of Health Services and Hospital Insurance. 1957. 
Siddons, PJ. Involvement of the Public Health Nurse in Mental Health. Can J Public Health, 1968, 

59:449. 
Task Force Reports on the Cost of Health Services in Canada. Delivery of Medical Care. Price of 

Medical Care. Public Health. #3 Minister of National Health & Welfare, 1969. 
Taylor, JA. The Health Branch of the B. C. Dept. of Health Services and Hospital Insurance. Can J 

Public Health, 1962. 
Taylor, Dr. JA. Some Objectives in Local Health Services. Presented to the B.C. Public Health 

Institute, March 59. 
Urquhart, MC. Ed. Historical Statistics of Canada. The MacMillan Company of Canada Ltd., 

Toronto. 1965. 
Wilson, Amy V. No Man Stands Alone. Sidney, B.C.: Gray's Publishing Co., 1965. 
Wooten M., Wood S, Barnes K. Shaping Preschoolers Play Behavior in the Child Health Confer- 
ence Waiting Room. Can J Public Health, 1970, 61-10. 
Young, Dr. H. Esson. Archives File, B.C. Provincial. 
Young, Dr. H. E. Full-time Health Units in British Columbia. Can J Public Health, March 1929, 

133-140. 



156 



APPENDICES 



157 



Appendix I 



FIRST APPOINTMENTS AS PUBLIC HEALTH NURSES OR 
SCHOOL NURSES TO NEW DISTRICTS BY YEAR* 



Miss Blanche Swan (Lewis) 
first provincial school nurse 

Miss M. Locke, 

second provincial school nurse 

Miss Gregg, School Nurse (M) 

Miss E. Foreshaw 

Miss Edna Gray (V.O.N., Red Cross, 
Prov.) 

Miss Bertha E. Hall 



1913 


Victoria 


1916 


Victoria 


1918 


Victoria 


1919 


Saanich Health Centre 




Keremeos 



1920 Cowichan Health Centre 
(Duncan) 

Esquimalt Rural (Langford) 

Nanaimo City 

1922 Kamloops 
Penticton 
Kelowna 

1923 Nanaimo Rural 
Sayward 

1924 Vernon 

Armstrong and Spullumcheen 

Fernie 

Ladysmith 

1925 Keremeos (reorganized) 

1926 Qualicum and District 

1927 Kamloops (reorganized) 

1928 Port Alberni 



ss Helen Kelly 

ss J.H. Woods 

ss Thorn (Red Cross, Prov.) 

ss Frances Whittaker 

ss Janet Hardy 

ss Amy Lee, School Nurse 

ss Edith Walls 

ss Jean Dunbar, School Nurse 

ss A.L. Mercer 

ss E.M. Wade, School Nurse 

ss M.A. Davie 

ss O. Gawley 

ss H. Murray 

ss Olive Garrood, School Nurse 

ss Mary Grierson 



*Public Health Nurse except where School Nurse indicated 
V.O.N. — Victorian Order of Nurses 
Prov. - Provincial funding 
M — Municipal funding 



(58 



Kelowna Rural 



Mrs. Anne F. Grindon 





Oliver 


M 




Chilliwack Municipality 


\1 


1929 


Maple Ridge and Mission 


M 


1930 


Chilliwack City 


M 




Penticton (reorganized) 


M 




Summerland 


M 




Revelstoke 


M 


1930 


North Vancouver 


M 
M 


1931 


Westbank 


M 




Lake Cowichan (Youbou) 


M 


1932 


Rolla 


M 


1935 


Ft. St. John 


M 




Dawson Creek 


M 




Progress 


M 




Abbotsford 


M 


1936 


Richmond 


M 
M 


1937 


Prince Rupert 


M 




Nelson 


M 



Burnaby 



West Vancouver 

I938 Matsqui — Sumas 
Abbotsford 



Maple Ridge 

Dewdney 

Gibson's 

Port Alberni (reorganized) 

1939 Lumby 

1940 Quesnel 

Fernie and District 
(reorganized) 



ss M.A. Twiddy (V.O.N.. Prov.) 

ss Winifred Green 

ss H. Fawcett (Moody) 

ss Helen Peters, School Nurse 

ss M.A. Twiddy 

ss O. Ings 

ss A.E. Lee 

ss Norah Armstrong (M.) 
ss E. Lowther (M.) 

ss Hilda Barton (V.O.N., Prov.) 

ss V. Miller (first resident) 

ss Nancy Dunn 

ss Nancy Cunningham 

ss Rita Mahon 

s. Pauline Yaholnitsky 

ss J. Arnould 

ss Muriel Upshall (M.) 
ss Eileen Williams (M.) 

ss Dorothy Priestly 

ss Kay Gordon (Williams) 
School Nurse 

Miss Mary Shand (M.) 
Miss Alice Thornloe (M.) 

Miss Ethel Brooks, School Nurse 

Miss Beth Ochs (Rotter) 

Miss Evelyn Maguire 

Miss Marion Miles (Pennington) 

Miss Anna Larson (Mason) 

Miss Mary Grierson 

Miss Lillian Wooding (V.O.N. , Prov.) 

Miss Joyce Leslie 

Miss Marion Bellis 

Mrs. Pauline Yaholnitsky 

Mrs. Joanne Daem (Brewster) 

159 



1940 Cranbrook 

1941 Creston and District 
Courtenay 

Coquitlam and Fraser Mills 
Kimberley 

1942 Sidney 

Cranbrook and District 
(reorganized) 

Prince George 

1943 Alberni 
Williams Lake 
Powell River 
Princeton 

1944 Rossland 
Cumberland 
Nakusp 

1945 Agassiz 
Campbell River 
Surrey Municipality 
Langley 

Hope and District 

Salmon Arm & District 

Esquimalt Municipality 
(reorganized) 

1946 Delta Municipality 
Oliver (reorganized) 
Alberni Canal 
Trail 

Slocan 

Fruitvale — Salmo 

Kamloops (reorganized) 



Miss Bertha Jenkins, School Nurse 

Miss Marion Miles (Pennington) 

Miss Alice Beattie 

Miss Freda Hilton 

Miss Anna Larson (Mason) 

Miss Kay Ellis (Richman) 

Miss Isabel Louks (Foster) 

Miss Eileen Snowden (Ramsay) 

Miss Mary Gregory 

Miss Viola Davies 

Miss Eleanor Graham 

Miss M. Betsy Quayle 

Miss Elizabeth Hahn 

Miss Lucille Giovando 

Miss Marjorie Staniforth (Wisby) 

Miss Betty Picard (Bradley) 

Miss Violet Hele 

Miss Ann Elyea (Hales) 

Miss Frances Stewart 

Miss Eileen Snowden (Ramsay) 

Miss Susie Jones 

Miss Phyllis Purslow (Swaisland) 

Miss Merle Franke (M.) 

Miss Barbara Smith 

Miss Janet Pallister (Bailey) 

Miss M. Betsy Quayle 

Miss Evelyn Teir 

Miss Nora Woods (Shannon) 

Miss Elizabeth Ochs (Rotter) 

Miss Margaret Campbell (Jackson) 



160 



1947 Smithers 
Vanderhoof 
Lillooet 

1948 Castlegar 
Invermere — Golden 
Burns Lake 
Barriere — Blue River 
Ocean Falls 

1949 Gibson's (reorganized) 
Ashcroft 
Greenwood 
Squamish 

1950 Salmo 

Salt Spring Island District 
Queen Charlotte Islands 
Merritt 
Kaslo 

1951 Salt Spring Island District 
Grand Forks 

1953 McBride 

1954 Prov. Govt. Employees' Health 
Service — Victoria 

1955 Kitimat 

1956 Terrace 

1957 Telegraph Creek (reorganized) 

1958 Golden — (separate district) 
1962 Port Hardy 

1971 Massett 

1972 MacKenzie 
Gold River 
Sparwood 



Miss Dorothy Brown (Vetterli) 

Miss Caroline Daouk 

Miss Aileen Bond 

Miss Kay Comerford 

Mrs. Kay Marshall (Reid) 

Miss Miriam Cressman 

Served from Kamloops 

Miss Ada O'Brien (Clegghorn) 

Miss Clara Nygren 

Miss Marion Boyd 

Miss Dorothy Newman 

Miss Lorraine Carruthers (Houghton) 

Miss Frances Hewgill (Mitchell) 
(resident nurse) 

Served from Sidney 

Served from Prince Rupert 

Served from Kamloops 

Served from Nelson 

Miss Elizabeth Layton (resident) 

Miss Marion Boyd 

Miss Pauline Siddons 

Mrs. Evelyn Dalman 

Miss Dorothy Kergin 

Miss Miriam Cressman 

Miss Lillian Whiteside 

Miss Jean Oliver 

Miss Freda Easy 

Miss Chizuko Furuya (Diemert) 

Miss Caroline Riddell (Andrews) 

Mrs. Faye Hurrell 

Mrs. Joan Seguin (part-time) 

Mrs. Lois Halko (part-time) 



Bella Coola 

Tahsis 

Gold River — Tahsis 

Vancouver City (M.) 
Miss E. Breeze 
Miss Elliott 
Miss Sanders 



Mrs. Lillian McComb (part-time) 
Mrs. Rebecca Bancroft (part-time) 
Mrs. May Douglas 

1910 School Nurse 

1919 Taberculosis Nurse 

1920 Child Welfare Nurse 



162 



Appendix II 



FIRST SENIORS AND SUPERVISORS OF PUBLIC HEALTH NURSING 
BY DISTRICT AND YEAR 



East Kootenay (Cranbrook) 

Miss Nora Woods (Shannon) 
Miss Nancy Lee 



Kootenay Region 



Miss Margaret Cammaert 



1947* 



Snr. 


1951-55 


Sup. 


1955-57 


Snr. 


1948-50 


Consultant 


1951-54 



Selkirk (Nelson) 



West Kootenay (Trail) 



1953 



Miss Margaret Latimer (Cormack) 
Miss Helen MacAleese 



Miss Alice Beattie 



North Oranagan (Vernon) 

Miss Grace White 
Miss Joan Russell 
Mrs. Evalyn Allingham (Greene) 

South Okanagan (Kelowna) 

Mrs. Madeline Werts 

Miss Alice Beattie 
Penticton Mrs. Anna Mason 

Rutland Miss Lula McComb 



Snr. 


1952-54 


Sup. 


1964 




1950 


Sup. 


1950-51 




1944 


Snr. 


1948-50 


Sup. 


1950-55 


Sup. 


1955-75 




1928 


Snr. 


1944-66 


Sup. 


1951-53 


Snr. 


1947-75 


Snr. 


1972-78 



South Central (Kamloops) 

Miss Lorraine Carruthers 

(Houghton) 
Miss Helene Boehme (Williams) 
North Kamloops Mrs. Joan Wilson 



1952 



Central Vancouver Island (Nanaimo) 
Nanaimo 



Miss Dorothy Priestly 
Mrs. Jessica Field 



Snr. 


1952-54 


Sup. 


1958-59 


Snr. 


1974- 




1943 


Sup. 


1946-65 


Snr. 


1957-64 



Cowichan Health Centre (Duncan) 
*Year health unit established. 



1919 



163 



Duncan Miss Bertha Jenkins 

(reorganized) Mrs. Florence Graham (Barbaree) 

Port Alberni Mrs. Maxine Smith (Bolton) 

Upper Island (Courtenay) 

Miss Margaret Whillans 
Miss Fern Primeau 

Coast Garibaldi (Powell River) 

Miss Annette Stark 
Miss Willa Davies 

Upper Fraser Valley (Chilliwack) 

Miss Nan Kennedy 
Miss Mary McKinley (Robertson) 
Abbotsford Miss Hedy Reimer 

Central Fraser (Maple Ridge) 

Reorganized in 1965 from North Fraser (Mission) 

Mrs. Patricia Kahr 
Miss Dorothy Ladner 

Simon Fraser (New Westminster) 

Miss Barbara Smith 
Coquitlam Mrs. Phyllis Madden (Dangerfield) 

New Westminster Miss Barbara Bryson 
Port Coquitlam Mrs. Diane Ouston 



Sup. 


1930-32 


Snr. 


1962-78 


Snr. 


1957-59 




1949 


Snr. 


1950-53 


Sup. 


1955-59 




1964 


Snr. 


1964-67 


Sup. 


1969-78 




1949 


Snr. 


1949-52 


Sup. 


1952-55 


Snr. 


1966-68 



Snr. 
Sup. 



Sup. 

Snr. 
Snr. 
Snr. 



1950 

1950-57 
1965-66 

1950 

1950-80 
1958-61 
1950-80 
1965-70 



undary (Cloverdale) 












1952 


Surrey Nursing 


Miss Janet Pallister 


(Bailey) 




Snr. 


1948-52 


District 














Boundary Health 


Miss Alice Beattie 








Sup. 


1953-56 


Unit 














Whalley 


Mrs. Jean Keays 








Snr. 


1959-80 


Cloverdale 


Miss Pat Knowlton 








Snr. 


1960-62 


Langley 


Miss Margaret Latimer (Cormack) 


Snr. 


1957-58 



(Langley became part of Central Fraser in 1965) 

Northern Region (Cariboo, Skeena, Peace River) 
Mrs. Pauline Yaholnitsky 

Northern Interior (Prince George) 

(Reorganized from old Cariboo in 1962) 

Miss Mary McKinley (Robertson) 
Miss Joan Sutcliffe 



Sup. 


1946-57 




1948 


Snr. 


1952-57 


Sup. 


1957-61 



164 



Cariboo (Williams Lake) 



Mrs. Helen Peters (Chernoff) 
Miss Ardice Buchanan 



Skeena (Prince Rupert) 



Terrace 



Miss Joyce Leslie 

Mrs. Helene Williams (Boehme) 

Mrs. Donna Beattie 



1962 



Snr. 


1962-65 


Sup. 


1965-76 




1942 


Snr. 


1946-47 


Sup. 


1951-58 


Snr. 


1971-73 



Peace River (Dawson Creek) 

Miss Aileen Bond 



1935 



Ft. St. John 

Saanich 

Health Centre 



Mrs. Helene Williams (Boehme) 
Miss Elizabeth Upton 



Mrs. C.A. Lucas 



Snr. 


1950-52 


Sup. 


1961-70 


Snr. 


1974-75 




1927 


Sup. 


1925 



Saanich and South Vancouver Island (Reorganized) 

Miss Dorothy Paulin (Smillie) Snr. 

Miss Mary Dunn (Manson) Sup. 

Metropolitan Board of Health for Greater Victoria (Reorganized) 
Director of Public Health Nursing 

Miss Joan Russell 



Vancouver Metropolitan Health Department 

Directors of Public Health Nursing 

Miss Elizabeth Breeze 
Miss Aletha McLellan 
Miss Lyle Creelman 
Miss Trenna Hunter 
Miss Eva Williamson 



Supervisors of Health Units 

Miss Margaret P. Campbell 

Miss O.E. Kilpatrick 

Miss E. Stoddart 

Miss Geraldine Homfray (Langton) 

Miss Muriel Upshall 

Miss Norah Armstrong 

Miss Mary Shand 

Supervisors in Special Services 
Tuberculosis Miss E.M. Elliott 

Child Hygiene Miss L. Saunders 

School Miss A. McLellan 



1937-38 
1938-41 
1941-44 
1946-66 

1967-77 

1937 
1937 
1937 
1937 
1937 
1937 
1938 

1937 
1937 
1937 



1947 

1946-47 
1948-58 

1961 

1961-64 

1937 



165 



Appendix HI 



CHANGES IN DIVISION OF PUBLIC HEALTH NURSING AND 

SPECIAL SERVICES 







Consultants, Van. 




Directors of 


Consultants 


& Regional 


Special 


P.H.N. 


Victoria 


Supervisors 


Services 



Heather Kilpatrick 


Dorothy Tate 


Pauline Yaholnitsky 


Tuberculosis 


(1940-44) 


1943-44 


1947-59 Regional 


Vancouver 


Dorothy Tate 


Helen Carpenter 


Supervisor, Northern 

Units 


Josephine Peters 


(Slaughter) 


1943-44 


1924-48 


1944-48 

Monica Frith (Green) 


Isabel Foster (Louks) 
1944-45 


Margaret Cammaert 
Regional Consultant 


Doris Bullock 
1948-50 


1948-75 




for Kootenays — 






Monica Frith 


1951-54 


Fern Primeau 


Lavinia Crane 


1944-48 


Vancouver 1954-55 


1950-55 


1976- 


Dorothy Paulin 


Dorothy Slaughter 


Venereal Disease 




(Smillie) 1948-49 


1955-75 Vancouver 






Margaret Campbell 
(Jackson) 1948-54 


Joyce Winter 
1975-82 Vancouver 


Alice Beattie 
1945 — Sup. 




Lucille Giovando 




Janet Kennedy 
1945 




(New position) 






1951-55 




Ann Murray 




Alice Beattie 




1945 




1956-74 




Nan Sewell 




Lavinia Crane 




1945 




1961-75 




Quennie Donaldson 




Pauline Siddons 




(Van.) 1946 




1968-81 




Occupational Health 




Diane Ouston 




Vic. 




1973- 




Evelyn Dalman 




Margaret Wilson 




1954-55 




(Baird) 1974- 




Alice Heron (King) 
1956-64 

Roma Worley 
1964-65 

Jessie McEachern 
1966 

Vancouver 

Yvonne Nedelec 
1961-76 

New Westmins. 
Area 

Joan Anderson 
1964-76 



166 



THROUGH THE YEARS 
WITH 
PUBLIC HEALTH Nl RSI> 





■ Mrs. Mo 












received . "\ ~ 
■ 

j V ' - * — . ■ - - 

u 


r* 






... f 


•..- 




. ' w "• 


**# 










If 










years of service. 












In 196"" Mrs Srcer^ 


•«P6- 










the ,Ame ' -., t-jiSmft'* 
FellcHv. 1 

InlV\s/ic- •» -'"*'--' 

V < i\ ■ ■ 


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